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Xanthouli P, Echampati I, Lorenz HM, Heussel CP, Benjamin N. Respiratory involvement in connective tissue diseases. Eur J Intern Med 2024; 120:11-16. [PMID: 37845118 DOI: 10.1016/j.ejim.2023.09.016] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/23/2023] [Revised: 09/01/2023] [Accepted: 09/15/2023] [Indexed: 10/18/2023]
Abstract
Pulmonary involvement is doubtless one the most fatal organ manifestations of the autoimmune rheumatic diseases (ARD) and involves the parenchyma, the vessels, the respiratory system itself, but also the muscles and the pleura. Close and regular screening assessments, identification of risk factors, clinical signs associated with the existence of lung disease should alarm the involved physicians treating these patients. The accurate classification is essential, as different treatment options are nowadays available. Pulmonary manifestations of ARD will be analyzed in this review article with special emphasis on interstitial lung disease and pulmonary hypertension.
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Affiliation(s)
- Panagiota Xanthouli
- Centre for Pulmonary Hypertension, Thoraxklinik Heidelberg gGmbH at Heidelberg University Hospital, Heidelberg, Germany; Division of Rheumatology, Department of Internal Medicine V: Hematology, Oncology and Rheumatology, University Hospital Heidelberg, Heidelberg, Germany; Translational Lung Research Centre Heidelberg, Member of the German Centre for Lung Research, Germany.
| | - Ishan Echampati
- Centre for Pulmonary Hypertension, Thoraxklinik Heidelberg gGmbH at Heidelberg University Hospital, Heidelberg, Germany; Translational Lung Research Centre Heidelberg, Member of the German Centre for Lung Research, Germany
| | - Hanns-Martin Lorenz
- Division of Rheumatology, Department of Internal Medicine V: Hematology, Oncology and Rheumatology, University Hospital Heidelberg, Heidelberg, Germany
| | - Claus Peter Heussel
- Translational Lung Research Centre Heidelberg, Member of the German Centre for Lung Research, Germany; Department of Diagnostic and Interventional Radiology with Nuclear Medicine, Thoraxklinik gGmbH at Heidelberg University Hospital, Heidelberg, Germany; Diagnostic and Interventional Radiology, Ruprecht-Karls-University, Heidelberg, Germany
| | - Nicola Benjamin
- Centre for Pulmonary Hypertension, Thoraxklinik Heidelberg gGmbH at Heidelberg University Hospital, Heidelberg, Germany; Translational Lung Research Centre Heidelberg, Member of the German Centre for Lung Research, Germany
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Muley T, Herth FJ, Heussel CP, Kriegsmann M, Thomas M, Meister M, Schneider MA, Wehnl B, Mang A, Holdenrieder S. Prognostic value of tumor markers ProGRP, NSE and CYFRA 21-1 in patients with small cell lung cancer and chemotherapy-induced remission. Tumour Biol 2024; 46:S219-S232. [PMID: 37840518 DOI: 10.3233/tub-230016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/17/2023] Open
Abstract
BACKGROUND Despite successful response to first line therapy, patients with small-cell lung cancer (SCLC) often suffer from early relapses and disease progression. OBJECTIVE To investigate the relevance of serum tumor markers for estimation of prognosis at several time points during the course of disease. METHODS In a prospective, single-center study, serial assessments of progastrin-releasing peptide (ProGRP), neuron-specific enolase (NSE), cytokeratin-19 fragments (CYFRA 21-1) and carcino-embryogenic antigen (CEA) were performed during and after chemotherapy in 232 SCLC patients, and correlated with therapy response and overall survival (OS). RESULTS ProGRP, NSE and CYFRA 21-1 levels decreased quickly after the first chemotherapy cycle and correlated well with the radiological response. Either as single markers or in combination they provided valuable prognostic information regarding OS at all timepoints investigated: prior to first-line therapy, after two treatment cycles in patients with successful response to first-line therapy, and prior to the start of second-line therapy. Furthermore, they were useful for continuous monitoring during and after therapy and often indicated progressive disease several months ahead of radiological changes. CONCLUSIONS The results indicate the great potential of ProGRP, NSE and CYFRA 21-1 for estimating prognosis and monitoring of SCLC patients throughout the course of the disease.
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Affiliation(s)
- Thomas Muley
- Translational Lung Research Centre Heidelberg, Member of the German Centre for Lung Research, Heidelberg, Germany
- Translational Research Unit, Thoraxklinik, Heidelberg University Hospital, Heidelberg, Germany
| | - Felix J Herth
- Translational Lung Research Centre Heidelberg, Member of the German Centre for Lung Research, Heidelberg, Germany
- Department of Pneumology and Respiratory Medicine, Thoraxklinik, University Hospital, Heidelberg, Germany
| | - Claus Peter Heussel
- Translational Lung Research Centre Heidelberg, Member of the German Centre for Lung Research, Heidelberg, Germany
- Diagnostic and Interventional Radiology, University Hospital, Heidelberg, Germany
- Institute of Pathology, University Hospital Heidelberg, Heidelberg, Germany
| | - Mark Kriegsmann
- Institute of Pathology, University Hospital Heidelberg, Heidelberg, Germany
- Pathology Wiesbaden, Wiesbaden, Germany
| | - Michael Thomas
- Translational Lung Research Centre Heidelberg, Member of the German Centre for Lung Research, Heidelberg, Germany
- Department of Oncology, Thoraxklinik, University Hospital, Heidelberg, Germany
| | - Michael Meister
- Translational Lung Research Centre Heidelberg, Member of the German Centre for Lung Research, Heidelberg, Germany
- Translational Research Unit, Thoraxklinik, Heidelberg University Hospital, Heidelberg, Germany
| | - Marc A Schneider
- Translational Lung Research Centre Heidelberg, Member of the German Centre for Lung Research, Heidelberg, Germany
- Translational Research Unit, Thoraxklinik, Heidelberg University Hospital, Heidelberg, Germany
| | | | - Anika Mang
- Roche Diagnostics GmbH, Penzberg, Germany
| | - Stefan Holdenrieder
- Munich Biomarker Research Center, Institute of Laboratory Medicine, German Heart Centre, Technical University of Munich, Munich, Germany
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Bodenberger AL, Konietzke P, Weinheimer O, Wagner WL, Stiller W, Weber TF, Heussel CP, Kauczor HU, Wielpütz MO. Quantification of airway wall contrast enhancement on virtual monoenergetic images from spectral computed tomography. Eur Radiol 2023; 33:5557-5567. [PMID: 36892642 PMCID: PMC10326154 DOI: 10.1007/s00330-023-09514-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2022] [Revised: 12/31/2022] [Accepted: 02/02/2023] [Indexed: 03/10/2023]
Abstract
OBJECTIVES Quantitative computed tomography (CT) plays an increasingly important role in phenotyping airway diseases. Lung parenchyma and airway inflammation could be quantified by contrast enhancement at CT, but its investigation by multiphasic examinations is limited. We aimed to quantify lung parenchyma and airway wall attenuation in a single contrast-enhanced spectral detector CT acquisition. METHODS For this cross-sectional retrospective study, 234 lung-healthy patients who underwent spectral CT in four different contrast phases (non-enhanced, pulmonary arterial, systemic arterial, and venous phase) were recruited. Virtual monoenergetic images were reconstructed from 40-160 keV, on which attenuations of segmented lung parenchyma and airway walls combined for 5th-10th subsegmental generations were assessed in Hounsfield Units (HU) by an in-house software. The spectral attenuation curve slope between 40 and 100 keV (λHU) was calculated. RESULTS Mean lung density was higher at 40 keV compared to that at 100 keV in all groups (p < 0.001). λHU of lung attenuation was significantly higher in the systemic (1.7 HU/keV) and pulmonary arterial phase (1.3 HU/keV) compared to that in the venous phase (0.5 HU/keV) and non-enhanced (0.2 HU/keV) spectral CT (p < 0.001). Wall thickness and wall attenuation were higher at 40 keV compared to those at 100 keV for the pulmonary and systemic arterial phase (p ≤ 0.001). λHU for wall attenuation was significantly higher in the pulmonary arterial (1.8 HU/keV) and systemic arterial (2.0 HU/keV) compared to that in the venous (0.7 HU/keV) and non-enhanced (0.3 HU/keV) phase (p ≤ 0.002). CONCLUSIONS Spectral CT may quantify lung parenchyma and airway wall enhancement with a single contrast phase acquisition, and may separate arterial and venous enhancement. Further studies are warranted to analyze spectral CT for inflammatory airway diseases. KEY POINTS • Spectral CT may quantify lung parenchyma and airway wall enhancement with a single contrast phase acquisition. • Spectral CT may separate arterial and venous enhancement of lung parenchyma and airway wall. • The contrast enhancement can be quantified by calculating the spectral attenuation curve slope from virtual monoenergetic images.
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Affiliation(s)
- Arndt Lukas Bodenberger
- Department of Diagnostic and Interventional Radiology, Heidelberg University Hospital, Im Neuenheimer Feld 420, 69120, Heidelberg, Germany
- Translational Lung Research Center Heidelberg (TLRC), German Center for Lung Research (DZL), Im Neuenheimer Feld 156, 69120, Heidelberg, Germany
| | - Philip Konietzke
- Department of Diagnostic and Interventional Radiology, Heidelberg University Hospital, Im Neuenheimer Feld 420, 69120, Heidelberg, Germany
- Translational Lung Research Center Heidelberg (TLRC), German Center for Lung Research (DZL), Im Neuenheimer Feld 156, 69120, Heidelberg, Germany
- Department of Diagnostic and Interventional Radiology With Nuclear Medicine, Thoraxklinik at University of Heidelberg, Röntgenstraße 1, 69126, Heidelberg, Germany
| | - Oliver Weinheimer
- Department of Diagnostic and Interventional Radiology, Heidelberg University Hospital, Im Neuenheimer Feld 420, 69120, Heidelberg, Germany
- Translational Lung Research Center Heidelberg (TLRC), German Center for Lung Research (DZL), Im Neuenheimer Feld 156, 69120, Heidelberg, Germany
- Department of Diagnostic and Interventional Radiology With Nuclear Medicine, Thoraxklinik at University of Heidelberg, Röntgenstraße 1, 69126, Heidelberg, Germany
| | - Willi Linus Wagner
- Department of Diagnostic and Interventional Radiology, Heidelberg University Hospital, Im Neuenheimer Feld 420, 69120, Heidelberg, Germany
- Translational Lung Research Center Heidelberg (TLRC), German Center for Lung Research (DZL), Im Neuenheimer Feld 156, 69120, Heidelberg, Germany
- Department of Diagnostic and Interventional Radiology With Nuclear Medicine, Thoraxklinik at University of Heidelberg, Röntgenstraße 1, 69126, Heidelberg, Germany
| | - Wolfram Stiller
- Department of Diagnostic and Interventional Radiology, Heidelberg University Hospital, Im Neuenheimer Feld 420, 69120, Heidelberg, Germany
- Translational Lung Research Center Heidelberg (TLRC), German Center for Lung Research (DZL), Im Neuenheimer Feld 156, 69120, Heidelberg, Germany
- Department of Diagnostic and Interventional Radiology With Nuclear Medicine, Thoraxklinik at University of Heidelberg, Röntgenstraße 1, 69126, Heidelberg, Germany
| | - Tim Frederik Weber
- Department of Diagnostic and Interventional Radiology, Heidelberg University Hospital, Im Neuenheimer Feld 420, 69120, Heidelberg, Germany
- Department of Diagnostic and Interventional Radiology With Nuclear Medicine, Thoraxklinik at University of Heidelberg, Röntgenstraße 1, 69126, Heidelberg, Germany
| | - Claus Peter Heussel
- Department of Diagnostic and Interventional Radiology, Heidelberg University Hospital, Im Neuenheimer Feld 420, 69120, Heidelberg, Germany
- Translational Lung Research Center Heidelberg (TLRC), German Center for Lung Research (DZL), Im Neuenheimer Feld 156, 69120, Heidelberg, Germany
- Department of Diagnostic and Interventional Radiology With Nuclear Medicine, Thoraxklinik at University of Heidelberg, Röntgenstraße 1, 69126, Heidelberg, Germany
| | - Hans-Ulrich Kauczor
- Department of Diagnostic and Interventional Radiology, Heidelberg University Hospital, Im Neuenheimer Feld 420, 69120, Heidelberg, Germany
- Translational Lung Research Center Heidelberg (TLRC), German Center for Lung Research (DZL), Im Neuenheimer Feld 156, 69120, Heidelberg, Germany
- Department of Diagnostic and Interventional Radiology With Nuclear Medicine, Thoraxklinik at University of Heidelberg, Röntgenstraße 1, 69126, Heidelberg, Germany
| | - Mark Oliver Wielpütz
- Department of Diagnostic and Interventional Radiology, Heidelberg University Hospital, Im Neuenheimer Feld 420, 69120, Heidelberg, Germany.
- Translational Lung Research Center Heidelberg (TLRC), German Center for Lung Research (DZL), Im Neuenheimer Feld 156, 69120, Heidelberg, Germany.
- Department of Diagnostic and Interventional Radiology With Nuclear Medicine, Thoraxklinik at University of Heidelberg, Röntgenstraße 1, 69126, Heidelberg, Germany.
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Kreuter M, Behr J, Bonella F, Costabel U, Gerber A, Hamer OW, Heussel CP, Jonigk D, Krause A, Koschel D, Leuschner G, Markart P, Nowak D, Pfeifer M, Prasse A, Wälscher J, Winter H, Kabitz HJ. [Consensus guideline on the interdisciplinary diagnosis of interstitial lung diseases]. Pneumologie 2023; 77:269-302. [PMID: 36977470 DOI: 10.1055/a-2017-8971] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/30/2023]
Abstract
The evaluation of a patient with interstitial lung disease (ILD) includes assessment of clinical, radiological, and often histopathological data. As there were no specific recommendations to guide the evaluation of patients under the suspicion of an ILD within the German practice landscape, this position statement from an interdisciplinary panel of ILD experts provides guidance related to the diagnostic modalities which should be used in the evaluation of ILD. This includes clinical assessment rheumatological evaluation, radiological examinations, histopathologic sampling and the need for a final discussion in a multidisciplinary team.
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Affiliation(s)
- Michael Kreuter
- Universitäres Lungenzentrum Mainz, Abteilungen für Pneumologie, ZfT, Universitätsmedizin Mainz und Pneumologie, Beatmungs- und Schlafmedizin, Marienhaus Klinikum Mainz
- Zentrum für interstitielle und seltene Lungenerkrankungen, Thoraxklinik, Universitätsklinikum Heidelberg und Klinik für Pneumologie, Klinikum Ludwigsburg
- Deutsches Zentrum für Lungenforschung
| | - Jürgen Behr
- Medizinische Klinik und Poliklinik V, LMU Klinikum der Universität München
- Deutsches Zentrum für Lungenforschung
| | - Francesco Bonella
- Zentrum für interstitielle und seltene Lungenerkrankungen, Ruhrlandklinik, Universitätsmedizin Essen
| | - Ulrich Costabel
- Zentrum für interstitielle und seltene Lungenerkrankungen, Ruhrlandklinik, Universitätsmedizin Essen
| | - Alexander Gerber
- Rheumazentrum Halensee, Berlin und Institut für Arbeits- Sozial- und Umweltmedizin, Goetheuniversität Frankfurt am Main
| | - Okka W Hamer
- Institut für Röntgendiagnostik, Universitätsklinikum Regensburg und Abteilung für Radiologie, Klinik Donaustauf, Donaustauf
| | - Claus Peter Heussel
- Diagnostische und interventionelle Radiologie, Thoraxklinik Heidelberg, Universitätsklinikum Heidelberg
- Deutsches Zentrum für Lungenforschung
| | - Danny Jonigk
- Institut für Pathologie, Medizinische Hochschule Hannover und Institut für Pathologie, RWTH Universitätsklinikum Aachen
- Deutsches Zentrum für Lungenforschung
| | - Andreas Krause
- Abteilung für Rheumatologie, klinische Immunologie und Osteologie, Immanuel Krankenhaus Berlin
| | - Dirk Koschel
- Abteilung für Innere Medizin und Pneumologie, Fachkrankenhaus Coswig, Lungenzentrum, Coswig und Bereich Pneumologie der Medizinischen Klinik, Carl Gustav Carus Universitätsklinik, Dresden
| | - Gabriela Leuschner
- Medizinische Klinik und Poliklinik V, LMU Klinikum der Universität München
- Deutsches Zentrum für Lungenforschung
| | - Philipp Markart
- Medizinische Klinik V, Campus Fulda, Universitätsmedizin Marburg und Medizinische Klinik und Poliklinik, Universitätsklinikum Gießen
- Deutsches Zentrum für Lungenforschung
| | - Dennis Nowak
- Institut und Poliklinik für Arbeits-, Sozial- und Umweltmedizin, LMU Klinikum, München
| | - Michael Pfeifer
- Klinik für Pneumologie und konservative Intensivmedizin, Krankenhaus Barmherzige Brüder Regensburg
| | - Antje Prasse
- Klinik für Pneumologie und Infektionsmedizin, Medizinische Hochschule Hannover und Abteilung für Fibroseforschung, Fraunhofer ITEM
- Deutsches Zentrum für Lungenforschung
| | - Julia Wälscher
- Zentrum für interstitielle und seltene Lungenerkrankungen, Ruhrlandklinik, Universitätsmedizin Essen
| | - Hauke Winter
- Abteilung für Thoraxchirurgie, Thoraxklinik, Universität Heidelberg, Heidelberg
- Deutsches Zentrum für Lungenforschung
| | - Hans-Joachim Kabitz
- II. Medizinische Klinik, Pneumologie und Internistische Intensivmedizin, Klinikum Konstanz, GLKN, Konstanz
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Rheinheimer S, Christopoulos P, Erdmann S, Saupe J, Golpon H, Vogel-Claussen J, Dinkel J, Thomas M, Heussel CP, Kauczor HU, Heussel G. Dynamic contrast enhanced MRI of pulmonary adenocarcinomas for early risk stratification: higher contrast uptake associated with response and better prognosis. BMC Med Imaging 2022; 22:215. [PMID: 36471318 PMCID: PMC9724354 DOI: 10.1186/s12880-022-00943-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2022] [Accepted: 11/28/2022] [Indexed: 12/12/2022] Open
Abstract
BACKGROUND To explore the prognostic value of serial dynamic contrast-enhanced (DCE) MRI in patients with advanced pulmonary adenocarcinoma undergoing first-line therapy with either tyrosine-kinase inhibitors (TKI) or platinum-based chemotherapy (PBC). METHODS Patients underwent baseline (day 0, n = 98), and post-therapeutic DCE MRI (PBC: day + 1, n = 52); TKI: day + 7, n = 46) at 1.5T. Perfusion curves were acquired at 10, 40, and 70 s after contrast application and analysed semiquantitatively. Treatment response was evaluated at 6 weeks by CT (RECIST 1.1); progression-free survival (PFS) and overall survival were analysed with respect to clinical and perfusion parameters. Relative uptake was defined as signal difference between contrast and non-contrast images, divided by the non-contrast signal. Predictors of survival were selected using Cox regression analysis. Median follow-up was 825 days. RESULTS In pre-therapeutic and early post-therapeutic MRI, treatment responders (n = 27) showed significantly higher relative contrast uptake within the tumor at 70 s after application as compared to non-responders (n = 71, p ≤ 0.02), response defined as PR by RECIST 1.1 at 6 weeks. There was no significant change of perfusion at early MRI after treatment. In multivariate regression analysis of selected parameters, the strongest association with PFS were relative uptake at 40 s in the early post-treatment MRI and pre-treatment clinical data (presence of liver metastases, ECOG performance status). CONCLUSION Higher contrast uptake within the tumor at pre-treatment and early post-treatment MRI was associated with treatment response and better prognosis. DCE MRI of pulmonary adenocarcinoma may provide important prognostic information.
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Affiliation(s)
- Stephan Rheinheimer
- grid.7700.00000 0001 2190 4373Diagnostic and Interventional Radiology with Nuclear Medicine, Thoraxklinik at University of Heidelberg, Röntgenstrasse 1, 69126 Heidelberg, Germany ,grid.5253.10000 0001 0328 4908Diagnostic and Interventional Radiology, University Hospital Heidelberg, Im Neuenheimer Feld 420, 69120 Heidelberg, Germany ,grid.7700.00000 0001 2190 4373Translational Lung Research Center Heidelberg (TLRC), University of Heidelberg, Im Neuenheimer Feld 420, 69120 Heidelberg, Germany ,Radiology, Asklepios Hospital Munich, Robert-Koch-Allee 2, 82131 Gauting, Germany
| | - Petros Christopoulos
- grid.7700.00000 0001 2190 4373Translational Lung Research Center Heidelberg (TLRC), University of Heidelberg, Im Neuenheimer Feld 420, 69120 Heidelberg, Germany ,grid.7700.00000 0001 2190 4373Thoracic Oncology, Thoraxklinik at University of Heidelberg, Röntgenstrasse 1, 69126 Heidelberg, Germany ,grid.452624.3German Center for Lung Research (DZL), Giessen, Germany
| | - Stella Erdmann
- Medical Biometry, Institute of Medical Biometry, Im Neuenheimer Feld 130.3, 69120 Heidelberg, Germany ,grid.452624.3German Center for Lung Research (DZL), Giessen, Germany
| | - Julia Saupe
- grid.7700.00000 0001 2190 4373Diagnostic and Interventional Radiology with Nuclear Medicine, Thoraxklinik at University of Heidelberg, Röntgenstrasse 1, 69126 Heidelberg, Germany ,grid.5253.10000 0001 0328 4908Diagnostic and Interventional Radiology, University Hospital Heidelberg, Im Neuenheimer Feld 420, 69120 Heidelberg, Germany ,grid.7700.00000 0001 2190 4373Translational Lung Research Center Heidelberg (TLRC), University of Heidelberg, Im Neuenheimer Feld 420, 69120 Heidelberg, Germany ,grid.452624.3German Center for Lung Research (DZL), Giessen, Germany
| | - Heiko Golpon
- grid.7700.00000 0001 2190 4373Translational Lung Research Center Heidelberg (TLRC), University of Heidelberg, Im Neuenheimer Feld 420, 69120 Heidelberg, Germany ,grid.10423.340000 0000 9529 9877Department of Respiratory Medicine, Hannover Medical School, Carl-Neuberg-Str. 1, 30625 Hannover, Germany ,grid.452624.3German Center for Lung Research (DZL), Giessen, Germany
| | - Jens Vogel-Claussen
- grid.7700.00000 0001 2190 4373Translational Lung Research Center Heidelberg (TLRC), University of Heidelberg, Im Neuenheimer Feld 420, 69120 Heidelberg, Germany ,Diagnostic and Interventional Radiology and Biomedical Research in Endstage and Obstructive Lung Disease Hannover (BREATH), Carl-Neuberg-Str. 1, 30625 Hannover, Germany ,grid.10423.340000 0000 9529 9877Institute of Diagnostic and Interventional Radiology, Hannover Medical School, Carl-Neuberg-Str. 1, 30625 Hannover, Germany ,grid.452624.3German Center for Lung Research (DZL), Giessen, Germany
| | - Julien Dinkel
- grid.7700.00000 0001 2190 4373Translational Lung Research Center Heidelberg (TLRC), University of Heidelberg, Im Neuenheimer Feld 420, 69120 Heidelberg, Germany ,Radiology, Asklepios Hospital Munich, Robert-Koch-Allee 2, 82131 Gauting, Germany ,grid.452624.3German Center for Lung Research (DZL), Giessen, Germany
| | - Michael Thomas
- grid.7700.00000 0001 2190 4373Translational Lung Research Center Heidelberg (TLRC), University of Heidelberg, Im Neuenheimer Feld 420, 69120 Heidelberg, Germany ,grid.7700.00000 0001 2190 4373Thoracic Oncology, Thoraxklinik at University of Heidelberg, Röntgenstrasse 1, 69126 Heidelberg, Germany ,grid.452624.3German Center for Lung Research (DZL), Giessen, Germany
| | - Claus Peter Heussel
- grid.7700.00000 0001 2190 4373Diagnostic and Interventional Radiology with Nuclear Medicine, Thoraxklinik at University of Heidelberg, Röntgenstrasse 1, 69126 Heidelberg, Germany ,grid.5253.10000 0001 0328 4908Diagnostic and Interventional Radiology, University Hospital Heidelberg, Im Neuenheimer Feld 420, 69120 Heidelberg, Germany ,grid.7700.00000 0001 2190 4373Translational Lung Research Center Heidelberg (TLRC), University of Heidelberg, Im Neuenheimer Feld 420, 69120 Heidelberg, Germany ,grid.452624.3German Center for Lung Research (DZL), Giessen, Germany
| | - Hans-Ulrich Kauczor
- grid.5253.10000 0001 0328 4908Diagnostic and Interventional Radiology, University Hospital Heidelberg, Im Neuenheimer Feld 420, 69120 Heidelberg, Germany ,grid.7700.00000 0001 2190 4373Translational Lung Research Center Heidelberg (TLRC), University of Heidelberg, Im Neuenheimer Feld 420, 69120 Heidelberg, Germany ,grid.452624.3German Center for Lung Research (DZL), Giessen, Germany
| | - Gudula Heussel
- grid.7700.00000 0001 2190 4373Diagnostic and Interventional Radiology with Nuclear Medicine, Thoraxklinik at University of Heidelberg, Röntgenstrasse 1, 69126 Heidelberg, Germany ,grid.7700.00000 0001 2190 4373Thoracic Oncology, Thoraxklinik at University of Heidelberg, Röntgenstrasse 1, 69126 Heidelberg, Germany ,grid.452624.3German Center for Lung Research (DZL), Giessen, Germany
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Kaaks R, Christodoulou E, Motsch E, Katzke V, Wielpütz MO, Kauczor HU, Heussel CP, Eichinger M, Delorme S. Lung function impairment in the German Lung Cancer Screening Intervention Study (LUSI): prevalence, symptoms, and associations with lung cancer risk, tumor histology and all-cause mortality. Transl Lung Cancer Res 2022; 11:1896-1911. [PMID: 36248328 PMCID: PMC9554689 DOI: 10.21037/tlcr-22-63] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2022] [Accepted: 06/06/2022] [Indexed: 12/01/2022]
Abstract
Background Lung cancer screening may provide a favorable opportunity for a spirometry examination, to diagnose participants with undiagnosed lung function impairments, or to improve targeting of computed tomography (CT) screening intensity in view of expected net benefit. Methods Spirometry was performed in the CT screening arm (n=2,029) of the German Lung Cancer Screening Intervention Study (LUSI)—a trial examining the effects of annual CT screening on lung cancer mortality, in 50–69-year-old long-term smokers. Participants were classified as having chronic obstructive pulmonary disease (COPD) [forced expiration in one second (FEV1)/forced vital lung capacity (FVC) <0.7], preserved ratio impaired spirometry (PRISm; FEV1/FVC ≥0.7 and FEV1% predicted <80%), or normal spirometry. Descriptive statistics were used to examine associations of COPD or PRISm with respiratory symptoms, and self-reported medical diagnoses of respiratory and other morbidities. Logistic regression and proportional hazards regression were used to examine associations of COPD and PRISm, as well as their self-reported medical diagnoses, with risks of lung cancer and all-cause mortality. Results A total of 1,987 screening arm participants (98%) provided interpretable spirometry measurements; of these, 34.3% had spirometric patterns consistent with either COPD (18.6%) or PRISm (15.7%). Two thirds of participants with COPD or PRISm were asymptomatic, and only 23% reported a previous medical diagnosis concordant with COPD. Participants reporting a diagnosis tended to be more often current and heavier smokers, and more often had respiratory symptoms, cardiovascular comorbidities, or more severe lung function impairments. Independently of smoking history, moderate-to-severe (GOLD 2–4) COPD (OR =2.14; 95% CI: 1.54–2.98), and PRISm (OR =2.68; 95% CI: 1.61–4.40), were associated with increased lung cancer risk. Lung cancer patients with PRISm less frequently had adenocarcinomas, and more often squamous cell or small cell tumors, compared to those with normal spirometry (n=45), and both PRISm and COPD were associated with more advanced lung cancer tumor stage for screen-detected cancers. PRISm and COPD, depending on GOLD stage, were also associated with about 2- to 4-fold increases in risk of overall mortality, which to 87 percent had causes other than lung cancer. Conclusions About one third of smokers eligible for lung cancer screening in Germany have COPD or PRISm. As these conditions were associated with detection of lung cancer, spirometry may help identify populations at high risk for death of lung cancer or other causes, and who might particularly benefit from CT screening.
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Affiliation(s)
- Rudolf Kaaks
- Division of Cancer Epidemiology (C020), German Cancer Research Center (DKFZ), Heidelberg, Germany
- Translational Lung Research Center Heidelberg (TLRC-H), the German Center for Lung Research (DZL), Heidelberg, Germany
| | - Evangelia Christodoulou
- Division of Cancer Epidemiology (C020), German Cancer Research Center (DKFZ), Heidelberg, Germany
- Translational Lung Research Center Heidelberg (TLRC-H), the German Center for Lung Research (DZL), Heidelberg, Germany
| | - Erna Motsch
- Division of Cancer Epidemiology (C020), German Cancer Research Center (DKFZ), Heidelberg, Germany
- Translational Lung Research Center Heidelberg (TLRC-H), the German Center for Lung Research (DZL), Heidelberg, Germany
| | - Verena Katzke
- Division of Cancer Epidemiology (C020), German Cancer Research Center (DKFZ), Heidelberg, Germany
- Translational Lung Research Center Heidelberg (TLRC-H), the German Center for Lung Research (DZL), Heidelberg, Germany
| | - Mark O. Wielpütz
- Translational Lung Research Center Heidelberg (TLRC-H), the German Center for Lung Research (DZL), Heidelberg, Germany
- Department of Diagnostic and Interventional Radiology with Nuclear Medicine, Thoraxklinik, University Hospital Heidelberg, Heidelberg, Germany
- Department of Diagnostic and Interventional Radiology, University Hospital Heidelberg, Heidelberg, Germany
| | - Hans-Ulrich Kauczor
- Translational Lung Research Center Heidelberg (TLRC-H), the German Center for Lung Research (DZL), Heidelberg, Germany
- Department of Diagnostic and Interventional Radiology with Nuclear Medicine, Thoraxklinik, University Hospital Heidelberg, Heidelberg, Germany
- Department of Diagnostic and Interventional Radiology, University Hospital Heidelberg, Heidelberg, Germany
| | - Claus Peter Heussel
- Translational Lung Research Center Heidelberg (TLRC-H), the German Center for Lung Research (DZL), Heidelberg, Germany
- Department of Diagnostic and Interventional Radiology with Nuclear Medicine, Thoraxklinik, University Hospital Heidelberg, Heidelberg, Germany
- Department of Diagnostic and Interventional Radiology, University Hospital Heidelberg, Heidelberg, Germany
| | - Monika Eichinger
- Translational Lung Research Center Heidelberg (TLRC-H), the German Center for Lung Research (DZL), Heidelberg, Germany
- Department of Diagnostic and Interventional Radiology with Nuclear Medicine, Thoraxklinik, University Hospital Heidelberg, Heidelberg, Germany
- Department of Diagnostic and Interventional Radiology, University Hospital Heidelberg, Heidelberg, Germany
| | - Stefan Delorme
- Department of Radiology, German Cancer Research Center (DKFZ), Heidelberg, Germany
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7
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Fink MA, Kades K, Bischoff A, Moll M, Schnell M, Küchler M, Köhler G, Sellner J, Heussel CP, Kauczor HU, Schlemmer HP, Maier-Hein K, Weber TF, Kleesiek J. Deep Learning-based Assessment of Oncologic Outcomes from Natural Language Processing of Structured Radiology Reports. Radiol Artif Intell 2022; 4:e220055. [PMID: 36204531 PMCID: PMC9530771 DOI: 10.1148/ryai.220055] [Citation(s) in RCA: 12] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2022] [Revised: 06/20/2022] [Accepted: 07/07/2022] [Indexed: 06/16/2023]
Abstract
PURPOSE To train a deep natural language processing (NLP) model, using data mined structured oncology reports (SOR), for rapid tumor response category (TRC) classification from free-text oncology reports (FTOR) and to compare its performance with human readers and conventional NLP algorithms. MATERIALS AND METHODS In this retrospective study, databases of three independent radiology departments were queried for SOR and FTOR dated from March 2018 to August 2021. An automated data mining and curation pipeline was developed to extract Response Evaluation Criteria in Solid Tumors-related TRCs for SOR for ground truth definition. The deep NLP bidirectional encoder representations from transformers (BERT) model and three feature-rich algorithms were trained on SOR to predict TRCs in FTOR. Models' F1 scores were compared against scores of radiologists, medical students, and radiology technologist students. Lexical and semantic analyses were conducted to investigate human and model performance on FTOR. RESULTS Oncologic findings and TRCs were accurately mined from 9653 of 12 833 (75.2%) queried SOR, yielding oncology reports from 10 455 patients (mean age, 60 years ± 14 [SD]; 5303 women) who met inclusion criteria. On 802 FTOR in the test set, BERT achieved better TRC classification results (F1, 0.70; 95% CI: 0.68, 0.73) than the best-performing reference linear support vector classifier (F1, 0.63; 95% CI: 0.61, 0.66) and technologist students (F1, 0.65; 95% CI: 0.63, 0.67), had similar performance to medical students (F1, 0.73; 95% CI: 0.72, 0.75), but was inferior to radiologists (F1, 0.79; 95% CI: 0.78, 0.81). Lexical complexity and semantic ambiguities in FTOR influenced human and model performance, revealing maximum F1 score drops of -0.17 and -0.19, respectively. CONCLUSION The developed deep NLP model reached the performance level of medical students but not radiologists in curating oncologic outcomes from radiology FTOR.Keywords: Neural Networks, Computer Applications-Detection/Diagnosis, Oncology, Research Design, Staging, Tumor Response, Comparative Studies, Decision Analysis, Experimental Investigations, Observer Performance, Outcomes Analysis Supplemental material is available for this article. © RSNA, 2022.
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8
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Yaung SJ, Woestmann C, Ju C, Ma XM, Gattam S, Zhou Y, Xi L, Pal S, Balasubramanyam A, Tikoo N, Heussel CP, Thomas M, Kriegsmann M, Meister M, Schneider MA, Herth FJ, Wehnl B, Diehn M, Alizadeh AA, Palma JF, Muley T. Early Assessment of Chemotherapy Response in Advanced Non-Small Cell Lung Cancer with Circulating Tumor DNA. Cancers (Basel) 2022; 14:cancers14102479. [PMID: 35626082 PMCID: PMC9139958 DOI: 10.3390/cancers14102479] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2022] [Revised: 05/12/2022] [Accepted: 05/15/2022] [Indexed: 11/16/2022] Open
Abstract
Monitoring treatment efficacy early during therapy could enable a change in treatment to improve patient outcomes. We report an early assessment of response to treatment in advanced NSCLC using a plasma-only strategy to measure changes in ctDNA levels after one cycle of chemotherapy. Plasma samples were collected from 92 patients with Stage IIIB-IV NSCLC treated with first-line chemo- or chemoradiation therapies in an observational, prospective study. Retrospective ctDNA analysis was performed using next-generation sequencing with a targeted 198-kb panel designed for lung cancer surveillance and monitoring. We assessed whether changes in ctDNA levels after one or two cycles of treatment were associated with clinical outcomes. Subjects with ≤50% decrease in ctDNA level after one cycle of chemotherapy had a lower 6-month progression-free survival rate (33% vs. 58%, HR 2.3, 95% CI 1.2 to 4.2, log-rank p = 0.009) and a lower 12-month overall survival rate (25% vs. 70%, HR 4.3, 95% CI 2.2 to 9.7, log-rank p < 0.001). Subjects with ≤50% decrease in ctDNA level after two cycles of chemotherapy also had shorter survival. Using non-invasive liquid biopsies to measure early changes in ctDNA levels in response to chemotherapy may help identify non-responders before standard-of-care imaging in advanced NSCLC.
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Affiliation(s)
- Stephanie J. Yaung
- Roche Sequencing Solutions, Inc., Pleasanton, CA 94588, USA; (X.M.M.); (L.X.); (J.F.P.)
- Correspondence: ; Tel.: +1-925-523-8824
| | | | - Christine Ju
- Roche Molecular Systems, Inc., Pleasanton, CA 94588, USA; (C.J.); (S.G.); (Y.Z.); (S.P.); (A.B.)
| | - Xiaoju Max Ma
- Roche Sequencing Solutions, Inc., Pleasanton, CA 94588, USA; (X.M.M.); (L.X.); (J.F.P.)
| | - Sandeep Gattam
- Roche Molecular Systems, Inc., Pleasanton, CA 94588, USA; (C.J.); (S.G.); (Y.Z.); (S.P.); (A.B.)
| | - Yiyong Zhou
- Roche Molecular Systems, Inc., Pleasanton, CA 94588, USA; (C.J.); (S.G.); (Y.Z.); (S.P.); (A.B.)
| | - Liu Xi
- Roche Sequencing Solutions, Inc., Pleasanton, CA 94588, USA; (X.M.M.); (L.X.); (J.F.P.)
| | - Subrata Pal
- Roche Molecular Systems, Inc., Pleasanton, CA 94588, USA; (C.J.); (S.G.); (Y.Z.); (S.P.); (A.B.)
| | - Aarthi Balasubramanyam
- Roche Molecular Systems, Inc., Pleasanton, CA 94588, USA; (C.J.); (S.G.); (Y.Z.); (S.P.); (A.B.)
| | - Nalin Tikoo
- Alector, Inc., South San Francisco, CA 94080, USA;
| | - Claus Peter Heussel
- Diagnostic and Interventional Radiology with Nuclear Medicine, Thoraxklinik, University Hospital, 69126 Heidelberg, Germany;
- Diagnostic and Interventional Radiology, University Hospital, 69120 Heidelberg, Germany
- Translational Lung Research Centre (TLRC) Heidelberg, Member of the German Centre for Lung Research (DZL), 69120 Heidelberg, Germany; (M.T.); (M.M.); (M.A.S.); (F.J.H.); (T.M.)
| | - Michael Thomas
- Translational Lung Research Centre (TLRC) Heidelberg, Member of the German Centre for Lung Research (DZL), 69120 Heidelberg, Germany; (M.T.); (M.M.); (M.A.S.); (F.J.H.); (T.M.)
- Translational Research Unit, Thoraxklinik at Heidelberg University Hospital, 69126 Heidelberg, Germany
| | - Mark Kriegsmann
- Institute of Pathology, University Hospital Heidelberg, 69120 Heidelberg, Germany;
| | - Michael Meister
- Translational Lung Research Centre (TLRC) Heidelberg, Member of the German Centre for Lung Research (DZL), 69120 Heidelberg, Germany; (M.T.); (M.M.); (M.A.S.); (F.J.H.); (T.M.)
- Translational Research Unit, Thoraxklinik at Heidelberg University Hospital, 69126 Heidelberg, Germany
| | - Marc A. Schneider
- Translational Lung Research Centre (TLRC) Heidelberg, Member of the German Centre for Lung Research (DZL), 69120 Heidelberg, Germany; (M.T.); (M.M.); (M.A.S.); (F.J.H.); (T.M.)
- Translational Research Unit, Thoraxklinik at Heidelberg University Hospital, 69126 Heidelberg, Germany
| | - Felix J. Herth
- Translational Lung Research Centre (TLRC) Heidelberg, Member of the German Centre for Lung Research (DZL), 69120 Heidelberg, Germany; (M.T.); (M.M.); (M.A.S.); (F.J.H.); (T.M.)
- Translational Research Unit, Thoraxklinik at Heidelberg University Hospital, 69126 Heidelberg, Germany
| | - Birgit Wehnl
- Roche Diagnostics GmbH, 82377 Penzberg, Germany;
| | - Maximilian Diehn
- Stanford Cancer Institute, Stanford University, Stanford, CA 94305, USA; (M.D.); (A.A.A.)
| | - Ash A. Alizadeh
- Stanford Cancer Institute, Stanford University, Stanford, CA 94305, USA; (M.D.); (A.A.A.)
| | - John F. Palma
- Roche Sequencing Solutions, Inc., Pleasanton, CA 94588, USA; (X.M.M.); (L.X.); (J.F.P.)
| | - Thomas Muley
- Translational Lung Research Centre (TLRC) Heidelberg, Member of the German Centre for Lung Research (DZL), 69120 Heidelberg, Germany; (M.T.); (M.M.); (M.A.S.); (F.J.H.); (T.M.)
- Translational Research Unit, Thoraxklinik at Heidelberg University Hospital, 69126 Heidelberg, Germany
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Melzig C, Do TD, Egenlauf B, Partovi S, Grünig E, Kauczor HU, Heussel CP, Rengier F. Diagnostic accuracy of automated 3D volumetry of cardiac chambers by CT pulmonary angiography for identification of pulmonary hypertension due to left heart disease. Eur Radiol 2022; 32:5222-5232. [PMID: 35267088 PMCID: PMC9279230 DOI: 10.1007/s00330-022-08663-0] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2021] [Revised: 01/07/2022] [Accepted: 02/13/2022] [Indexed: 11/28/2022]
Abstract
OBJECTIVES To assess diagnostic accuracy of automated 3D volumetry of cardiac chambers based on computed tomography pulmonary angiography (CTPA) for the differentiation of pulmonary hypertension due to left heart disease (group 2 PH) from non-group 2 PH compared to manual diameter measurements. METHODS Patients with confirmed PH undergoing right heart catheterisation and CTPA within 100 days for diagnostic workup of PH between August 2013 and February 2016 were included in this retrospective, single-centre study. Automated 3D segmentation of left atrium, left ventricle, right atrium and right ventricle (LA/LV/RA/RV) was performed by two independent and blinded radiologists using commercial software. For comparison, axial diameters were manually measured. The ability to differentiate group 2 PH from non-group 2 PH was assessed by means of logistic regression. RESULTS Ninety-one patients (median 67.5 years, 44 women) were included, thereof 19 patients (20.9%) classified as group 2 PH. After adjustment for age, sex and mean pulmonary arterial pressure, group 2 PH was significantly associated with larger LA volume (p < 0.001), larger LV volume (p = 0.001), lower RV/LV volume ratio (p = 0.04) and lower RV/LA volume ratio (p = 0.003). LA volume demonstrated the highest discriminatory ability to identify group 2 PH (AUC, 0.908; 95% confidence interval, 0.835-0.981) and was significantly superior to LA diameter (p = 0.009). Intraobserver and interobserver agreements were excellent for all volume measurements (intraclass correlation coefficients 0.926-0.999, all p < 0.001). CONCLUSIONS LA volume quantified by automated, CTPA-based 3D volumetry can differentiate group 2 PH from other PH groups with good diagnostic accuracy and yields significantly higher diagnostic accuracy than left atrial diameter. KEY POINTS • Automated cardiac chamber volumetry using non-gated CT pulmonary angiography can differentiate pulmonary hypertension due to left heart disease from other causes with good diagnostic accuracy. • Left atrial volume yields significantly higher diagnostic accuracy than left atrial axial diameter for identification of pulmonary hypertension due to left heart disease without time-consuming manual processing.
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Affiliation(s)
- Claudius Melzig
- Clinic for Diagnostic and Interventional Radiology, Heidelberg University Hospital, Im Neuenheimer Feld 420, 69120, Heidelberg, Germany.,Translational Lung Research Center Heidelberg (TLRC), Member of the German Center for Lung Research (DZL), University of Heidelberg, Im Neuenheimer Feld 420, 69120, Heidelberg, Germany
| | - Thuy Duong Do
- Clinic for Diagnostic and Interventional Radiology, Heidelberg University Hospital, Im Neuenheimer Feld 420, 69120, Heidelberg, Germany.,Translational Lung Research Center Heidelberg (TLRC), Member of the German Center for Lung Research (DZL), University of Heidelberg, Im Neuenheimer Feld 420, 69120, Heidelberg, Germany
| | - Benjamin Egenlauf
- Translational Lung Research Center Heidelberg (TLRC), Member of the German Center for Lung Research (DZL), University of Heidelberg, Im Neuenheimer Feld 420, 69120, Heidelberg, Germany.,Centre for Pulmonary Hypertension, Thoraxklinik at Heidelberg University Hospital, Röntgenstraße 1, 69126, Heidelberg, Germany
| | - Sasan Partovi
- Department of Interventional Radiology, Cleveland Clinic Main Campus, 9500 Euclid Avenue, Cleveland, OH, 44195, USA
| | - Ekkehard Grünig
- Translational Lung Research Center Heidelberg (TLRC), Member of the German Center for Lung Research (DZL), University of Heidelberg, Im Neuenheimer Feld 420, 69120, Heidelberg, Germany.,Centre for Pulmonary Hypertension, Thoraxklinik at Heidelberg University Hospital, Röntgenstraße 1, 69126, Heidelberg, Germany
| | - Hans-Ulrich Kauczor
- Clinic for Diagnostic and Interventional Radiology, Heidelberg University Hospital, Im Neuenheimer Feld 420, 69120, Heidelberg, Germany.,Translational Lung Research Center Heidelberg (TLRC), Member of the German Center for Lung Research (DZL), University of Heidelberg, Im Neuenheimer Feld 420, 69120, Heidelberg, Germany
| | - Claus Peter Heussel
- Clinic for Diagnostic and Interventional Radiology, Heidelberg University Hospital, Im Neuenheimer Feld 420, 69120, Heidelberg, Germany.,Translational Lung Research Center Heidelberg (TLRC), Member of the German Center for Lung Research (DZL), University of Heidelberg, Im Neuenheimer Feld 420, 69120, Heidelberg, Germany.,Department of Radiology, Thoraxklinik at Heidelberg University Hospital, Röntgenstraße 1, 69126, Heidelberg, Germany
| | - Fabian Rengier
- Clinic for Diagnostic and Interventional Radiology, Heidelberg University Hospital, Im Neuenheimer Feld 420, 69120, Heidelberg, Germany. .,Translational Lung Research Center Heidelberg (TLRC), Member of the German Center for Lung Research (DZL), University of Heidelberg, Im Neuenheimer Feld 420, 69120, Heidelberg, Germany.
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10
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Ball M, Christopoulos P, Kirchner M, Allgaeuer M, Brandt R, Winter H, Heussel CP, Herth F, Froehling S, Savai R, Kriegsmann M, Schirmacher P, Peters S, Thomas M, Stenzinger A, Kazdal D. Histological and Molecular Plasticity of ALK-positive Non-Small-Cell Lung Cancer under Targeted Therapy - a Case Report. Cold Spring Harb Mol Case Stud 2022; 8:mcs.a006156. [PMID: 35058282 PMCID: PMC9059782 DOI: 10.1101/mcs.a006156] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2021] [Accepted: 12/22/2021] [Indexed: 11/24/2022] Open
Abstract
With medical progress in cancer therapy, tyrosine kinase inhibitors (TKIs) became a standard of care for many cancer types. But the broad range of possible targeted therapies was accompanied by a plethora of potential resistance mechanisms, of which many have still to be identified. Here, we present the case of a patient with an EML4–ALK translocated non-small-cell lung cancer treated with four different TKIs. Her tumor developed not only a well-known ALK–TKI resistance mutation but also underwent a histological transformation from adenocarcinoma to squamous cell carcinoma. To confirm a shared monoclonal origin of the phenotypically different tumors, a phylogenetic reconstruction was conducted: This revealed a cluster of mutations including NFE2L2, KMT2D, and MLH1, which are possible triggering events for the transformation.
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11
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Torrisi SE, Kahn N, Wälscher J, Polke M, Lee JS, Molyneaux PL, Sambataro FM, Heussel CP, Vancheri C, Kreuter M. Outcomes and Incidence of PF-ILD According to Different Definitions in a Real-World Setting. Front Pharmacol 2021; 12:790204. [PMID: 34975486 PMCID: PMC8718675 DOI: 10.3389/fphar.2021.790204] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2021] [Accepted: 11/22/2021] [Indexed: 12/28/2022] Open
Abstract
Background: Almost one-third of fibrosing ILD (fILDs) have a clinical disease behavior similar to IPF, demonstrating a progressive phenotype (PF-ILD). However, there are no globally accepted criteria on the definition of a progressive phenotype in non-IPF fILD yet. Four different definitions have been used; however, no internationally accepted definition currently exists. Research Question: To compare the clinical and functional characteristics of progressive fILD according to the currently available definitions. Study design and methods: Cases of fILD were identified retrospectively from the database of the tertiary referral center for ILD in Heidelberg. Lung function, clinical signs of progression, and radiological changes were evaluated. Patients with fILD were considered to have progression according to each of the four available definitions: Cottin (CO), RELIEF (RE), INBUILD (IN), and UILD study. Lung function changes, expressed as mean absolute decline of FVC%, were reported every 3 months following diagnosis and analyzed in the context of each definition. Survival was also analyzed. Results: A total of 566 patients with non-IPF fILD were included in the analysis. Applying CO-, RE-, IN-, and UILD-definitions, 232 (41%), 183 (32%), 274 (48%), and 174 (31%) patients were defined as PF-ILD, respectively. RE- and UILD-criteria were the most stringent, with only 32 and 31% patients defined as progressive, while IN- was the most broad, with almost 50% of patients defined as progressive. CO- definition was in-between, classifying 41% as progressive. PF ILD patients with a UILD definition had worse prognosis. Interpretation: Depending on the definition used, the existing criteria identify different groups of patients with progressive fILD, and this may have important prognostic and therapeutic implications.
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Affiliation(s)
- Sebastiano Emanuele Torrisi
- Center for Interstitial and Rare Lung Diseases, Pneumology, Thoraxklinik, University of Heidelberg and German Center for Lung Research, Heidelberg, Germany
- Regional Referral Centre for Rare Lung Diseases, A.O.U. Policlinico-San Marco, Department of Clinical and Experimental Medicine, University of Catania, Catania, Italy
| | - Nicolas Kahn
- Center for Interstitial and Rare Lung Diseases, Pneumology, Thoraxklinik, University of Heidelberg and German Center for Lung Research, Heidelberg, Germany
| | - Julia Wälscher
- Center for Interstitial and Rare Lung Diseases, Pneumology, Thoraxklinik, University of Heidelberg and German Center for Lung Research, Heidelberg, Germany
| | - Markus Polke
- Center for Interstitial and Rare Lung Diseases, Pneumology, Thoraxklinik, University of Heidelberg and German Center for Lung Research, Heidelberg, Germany
| | - Joyce S. Lee
- Anschutz Medical Campus, Department of Medicine, University of Colorado Denver, Aurora, CO, United States
| | - Philip L. Molyneaux
- National Heart and Lung Institute, Imperial College London, London, United Kingdom
- Royal Brompton Hospital, London, United Kingdom
| | - Francesca Maria Sambataro
- Radiology, Thoraxklinik, University of Heidelberg and German Center for Lung Research, Heidelberg, Germany
| | - Claus Peter Heussel
- Radiology, Thoraxklinik, University of Heidelberg and German Center for Lung Research, Heidelberg, Germany
| | - Carlo Vancheri
- Regional Referral Centre for Rare Lung Diseases, A.O.U. Policlinico-San Marco, Department of Clinical and Experimental Medicine, University of Catania, Catania, Italy
| | - Michael Kreuter
- Center for Interstitial and Rare Lung Diseases, Pneumology, Thoraxklinik, University of Heidelberg and German Center for Lung Research, Heidelberg, Germany
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12
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Giannakis A, Móré D, Erdmann S, Kintzelé L, Fischer RM, Vogel MN, Mangold DL, von Stackelberg O, Schnitzler P, Zimmermann S, Heussel CP, Kauczor HU, Hellbach K. COVID-19 pneumonia and its lookalikes: How radiologists perform in differentiating atypical pneumonias. Eur J Radiol 2021; 144:110002. [PMID: 34700092 PMCID: PMC8524806 DOI: 10.1016/j.ejrad.2021.110002] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2021] [Revised: 10/11/2021] [Accepted: 10/14/2021] [Indexed: 12/12/2022]
Abstract
Purpose To examine the performance of radiologists in differentiating COVID-19 from non-COVID-19 atypical pneumonia and to perform an analysis of CT patterns in a study cohort including viral, fungal and atypical bacterial pathogens. Methods Patients with positive RT-PCR tests for COVID-19 pneumonia (n = 90) and non-COVID-19 atypical pneumonia (n = 294) were retrospectively included. Five radiologists, blinded to the pathogen test results, assessed the CT scans and classified them as COVID-19 or non-COVID-19 pneumonia. For both groups specific CT features were recorded and a multivariate logistic regression model was used to calculate their ability to predict COVID-19 pneumonia. Results The radiologists differentiated between COVID-19 and non-COVID-19 pneumonia with an overall accuracy, sensitivity, and specificity of 88% ± 4 (SD), 79% ± 6 (SD), and 90% ± 6 (SD), respectively. The percentage of correct ratings was lower in the early and late stage of COVID-19 pneumonia compared to the progressive and peak stage (68 and 71% vs 85 and 89%). The variables associated with the most increased risk of COVID-19 pneumonia were band like subpleural opacities (OR 5.55, p < 0.001), vascular enlargement (OR 2.63, p = 0.071), and subpleural curvilinear lines (OR 2.52, p = 0.021). Bronchial wall thickening and centrilobular nodules were associated with decreased risk of COVID-19 pneumonia with OR of 0.30 (p = 0.013) and 0.10 (p < 0.001), respectively. Conclusions Radiologists can differentiate between COVID-19 and non-COVID-19 atypical pneumonias at chest CT with high overall accuracy, although a lower performance was observed in the early and late stage of COVID 19 pneumonia. Specific CT features might help to make the correct diagnosis.
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Affiliation(s)
- Athanasios Giannakis
- Department of Diagnostic and Interventional Radiology, Heidelberg University Hospital, Heidelberg, Germany; Diagnostic and Interventional Radiology with Nuclear Medicine, Thoraxklinik at University Hospital Heidelberg, Heidelberg, Germany; Translational Lung Research Center (TLRC), Member of the German Center for Lung Research (DZL), University of Heidelberg, Heidelberg, Germany.
| | - Dorottya Móré
- Department of Diagnostic and Interventional Radiology, Heidelberg University Hospital, Heidelberg, Germany; Translational Lung Research Center (TLRC), Member of the German Center for Lung Research (DZL), University of Heidelberg, Heidelberg, Germany
| | - Stella Erdmann
- Institute of Medical Biometry and Informatics, University of Heidelberg, Heidelberg, Germany
| | - Laurent Kintzelé
- Department of Diagnostic and Interventional Radiology, Heidelberg University Hospital, Heidelberg, Germany; Diagnostic and Interventional Radiology with Nuclear Medicine, Thoraxklinik at University Hospital Heidelberg, Heidelberg, Germany
| | - Ralph Michael Fischer
- Diagnostic and Interventional Radiology with Nuclear Medicine, Thoraxklinik at University Hospital Heidelberg, Heidelberg, Germany; Translational Lung Research Center (TLRC), Member of the German Center for Lung Research (DZL), University of Heidelberg, Heidelberg, Germany
| | - Monika Nadja Vogel
- Diagnostic and Interventional Radiology with Nuclear Medicine, Thoraxklinik at University Hospital Heidelberg, Heidelberg, Germany; Translational Lung Research Center (TLRC), Member of the German Center for Lung Research (DZL), University of Heidelberg, Heidelberg, Germany
| | - David Lukas Mangold
- Department of Diagnostic and Interventional Radiology, Heidelberg University Hospital, Heidelberg, Germany; Translational Lung Research Center (TLRC), Member of the German Center for Lung Research (DZL), University of Heidelberg, Heidelberg, Germany
| | - Oyunbileg von Stackelberg
- Department of Diagnostic and Interventional Radiology, Heidelberg University Hospital, Heidelberg, Germany; Translational Lung Research Center (TLRC), Member of the German Center for Lung Research (DZL), University of Heidelberg, Heidelberg, Germany
| | - Paul Schnitzler
- Department of Infectious Diseases, Virology, Heidelberg University, Heidelberg, Germany
| | - Stefan Zimmermann
- Medical Microbiology and Hygiene, Heidelberg University Hospital, Heidelberg, Germany
| | - Claus Peter Heussel
- Department of Diagnostic and Interventional Radiology, Heidelberg University Hospital, Heidelberg, Germany; Diagnostic and Interventional Radiology with Nuclear Medicine, Thoraxklinik at University Hospital Heidelberg, Heidelberg, Germany; Translational Lung Research Center (TLRC), Member of the German Center for Lung Research (DZL), University of Heidelberg, Heidelberg, Germany
| | - Hans-Ulrich Kauczor
- Department of Diagnostic and Interventional Radiology, Heidelberg University Hospital, Heidelberg, Germany; Translational Lung Research Center (TLRC), Member of the German Center for Lung Research (DZL), University of Heidelberg, Heidelberg, Germany
| | - Katharina Hellbach
- Department of Diagnostic and Interventional Radiology, Heidelberg University Hospital, Heidelberg, Germany; Diagnostic and Interventional Radiology with Nuclear Medicine, Thoraxklinik at University Hospital Heidelberg, Heidelberg, Germany; Translational Lung Research Center (TLRC), Member of the German Center for Lung Research (DZL), University of Heidelberg, Heidelberg, Germany
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Warwas KM, Meyer M, Gonçalves M, Moldenhauer G, Bulbuc N, Knabe S, Luckner-Minden C, Ziegelmeier C, Heussel CP, Zörnig I, Jäger D, Momburg F. Co-Stimulatory Bispecific Antibodies Induce Enhanced T Cell Activation and Tumor Cell Killing in Breast Cancer Models. Front Immunol 2021; 12:719116. [PMID: 34484225 PMCID: PMC8415424 DOI: 10.3389/fimmu.2021.719116] [Citation(s) in RCA: 16] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2021] [Accepted: 07/27/2021] [Indexed: 12/14/2022] Open
Abstract
Although T cell-recruiting CD3-binding bispecific antibodies (BiMAb) have been proven to be clinically effective for hematologic malignancies, the success of BiMAb targeting solid tumor-associated antigens (TAA) in carcinomas so far remains poor. We reasoned that provision of co-stimulatory BiMAb in combination with αTAA-αCD3 BiMAb would boost T cell activation and proliferative capacity, and thereby facilitate the targeting of weakly or heterogeneously expressed tumor antigens. Various αTAA-αCD3 and αTAA-αCD28 BiMAb in a tetravalent IgG1-Fc based format have been analyzed, targeting multiple breast cancer antigens including HER2, EGFR, CEA, and EpCAM. Moreover, bifunctional fusion proteins of αTAA-tumor necrosis factor ligand (TNFL) superfamily members including 4-1BBL, OX40L, CD70 and TL1A have been tested. The functional activity of BiMAb was assessed using co-cultures of tumor cell lines and purified T cells in monolayer and tumor spheroid models. Only in the presence of tumor cells, αTAA-αCD3 BiMAb activated T cells and induced cytotoxicity in vitro, indicating a strict dependence on cross-linking. Combination treatment of αTAA-αCD3 BiMAb and co-stimulatory αTAA-αCD28 or αTAA-TNFL fusion proteins drastically enhanced T cell activation in terms of proliferation, activation marker expression, cytokine secretion and tumor cytotoxicity. Furthermore, BiMAb providing co-stimulation were shown to reduce the minimally required dose to achieve T cell activation by at least tenfold. Immuno-suppressive effects of TGF-β and IL-10 on T cell activation and memory cell formation could be overcome by co-stimulation. BiMAb-mediated co-stimulation was further augmented by immune checkpoint-inhibiting antibodies. Effective co-stimulation could be achieved by targeting a second breast cancer antigen, or by targeting fibroblast activation protein (FAP) expressed on another target cell. In tumor spheroids derived from pleural effusions of breast cancer patients, co-stimulatory BiMAb were essential for the activation tumor-infiltrating lymphocytes and cytotoxic anti-tumor responses against breast cancer cells. Taken together we showed that co-stimulation significantly potentiated the tumoricidal activity of T cell-activating BiMAb while preserving the dependence on TAA recognition. This approach could provide for a more localized activation of the immune system with higher efficacy and reduced peripheral toxicities.
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Affiliation(s)
- Karsten M. Warwas
- Clinical Cooperation Unit Applied Tumor Immunity, German Cancer Research Center (DKFZ), Heidelberg, Germany
- Antigen Presentation and T/NK Cell Activation Group, DKFZ, Heidelberg, Germany
| | - Marten Meyer
- Clinical Cooperation Unit Applied Tumor Immunity, German Cancer Research Center (DKFZ), Heidelberg, Germany
- Antigen Presentation and T/NK Cell Activation Group, DKFZ, Heidelberg, Germany
| | - Márcia Gonçalves
- Clinical Cooperation Unit Applied Tumor Immunity, German Cancer Research Center (DKFZ), Heidelberg, Germany
- Antigen Presentation and T/NK Cell Activation Group, DKFZ, Heidelberg, Germany
| | | | - Nadja Bulbuc
- Antigen Presentation and T/NK Cell Activation Group, DKFZ, Heidelberg, Germany
| | - Susanne Knabe
- Clinical Cooperation Unit Applied Tumor Immunity, German Cancer Research Center (DKFZ), Heidelberg, Germany
| | - Claudia Luckner-Minden
- Department of Medical Oncology, National Center for Tumor Diseases (NCT), University Hospital, Heidelberg, Germany
| | - Claudia Ziegelmeier
- Department of Medical Oncology, National Center for Tumor Diseases (NCT), University Hospital, Heidelberg, Germany
| | - Claus Peter Heussel
- Diagnostic and Interventional Radiology With Nuclear Medicine, Thoraxklinik at Heidelberg University Hospital, Heidelberg, Germany
- Department of Diagnostic and Interventional Radiology, University Hospital, Heidelberg, Germany
- Translational Lung Research Center Heidelberg (TLRC), German Lung Research Center (DZL), Heidelberg, Germany
| | - Inka Zörnig
- Department of Medical Oncology, National Center for Tumor Diseases (NCT), University Hospital, Heidelberg, Germany
| | - Dirk Jäger
- Clinical Cooperation Unit Applied Tumor Immunity, German Cancer Research Center (DKFZ), Heidelberg, Germany
- Department of Medical Oncology, National Center for Tumor Diseases (NCT), University Hospital, Heidelberg, Germany
| | - Frank Momburg
- Antigen Presentation and T/NK Cell Activation Group, DKFZ, Heidelberg, Germany
- Department of Medical Oncology, National Center for Tumor Diseases (NCT), University Hospital, Heidelberg, Germany
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14
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Giannakis A, Móré D, Mangold DL, von Stackelberg O, Rubtsov R, Heussel CP, Kauczor HU, Wielpütz MO, Hellbach K. Simultaneous presence of the "bullseye" and "reversed halo" sign at CT of COVID-19 pneumonia: A case report. Radiol Case Rep 2021; 16:2442-2446. [PMID: 34099964 PMCID: PMC8173481 DOI: 10.1016/j.radcr.2021.05.074] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2021] [Accepted: 05/28/2021] [Indexed: 11/15/2022] Open
Abstract
The "bullseye" sign has been exclusively reported in patients suffering from coronavirus disease 2019 (COVID-19) pneumonia. It is theorized that this newly recognized computed tomography (CT) feature represents a sign of organizing pneumonia. Well established signs of organizing pneumonia also reported in COVID-19 patients include linear opacities, the "reversed halo" sign (or "atoll" sign), and a perilobular distribution of abnormalities. These findings are usually present on imaging in the intermediate and late stage of the disease. This is a case of simultaneous presence of the "bullseye" and the "reversed halo" sign on chest CT images of a COVID-19 patient examined 22 days after symptom onset.
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Affiliation(s)
- Athanasios Giannakis
- Department of Diagnostic and Interventional Radiology, Heidelberg University Hospital, Im Neuenheimer Feld 420, 69120 Heidelberg, Germany.,Diagnostic and Interventional Radiology with Nuclear Medicine, Thoraxklinik at University Hospital Heidelberg, Heidelberg, Germany.,Translational Lung Research Center (TLRC), German Center for Lung Research (DZL), University of Heidelberg, Heidelberg, Germany
| | - Dorottya Móré
- Department of Diagnostic and Interventional Radiology, Heidelberg University Hospital, Im Neuenheimer Feld 420, 69120 Heidelberg, Germany.,Translational Lung Research Center (TLRC), German Center for Lung Research (DZL), University of Heidelberg, Heidelberg, Germany
| | - David Lukas Mangold
- Department of Diagnostic and Interventional Radiology, Heidelberg University Hospital, Im Neuenheimer Feld 420, 69120 Heidelberg, Germany.,Translational Lung Research Center (TLRC), German Center for Lung Research (DZL), University of Heidelberg, Heidelberg, Germany
| | - Oyunbileg von Stackelberg
- Department of Diagnostic and Interventional Radiology, Heidelberg University Hospital, Im Neuenheimer Feld 420, 69120 Heidelberg, Germany.,Translational Lung Research Center (TLRC), German Center for Lung Research (DZL), University of Heidelberg, Heidelberg, Germany
| | - Roman Rubtsov
- Department of Diagnostic and Interventional Radiology, Klinikum Konstanz, Konstanz, Germany
| | - Claus Peter Heussel
- Department of Diagnostic and Interventional Radiology, Heidelberg University Hospital, Im Neuenheimer Feld 420, 69120 Heidelberg, Germany.,Diagnostic and Interventional Radiology with Nuclear Medicine, Thoraxklinik at University Hospital Heidelberg, Heidelberg, Germany.,Translational Lung Research Center (TLRC), German Center for Lung Research (DZL), University of Heidelberg, Heidelberg, Germany
| | - Hans-Ulrich Kauczor
- Department of Diagnostic and Interventional Radiology, Heidelberg University Hospital, Im Neuenheimer Feld 420, 69120 Heidelberg, Germany.,Translational Lung Research Center (TLRC), German Center for Lung Research (DZL), University of Heidelberg, Heidelberg, Germany
| | - Mark Oliver Wielpütz
- Department of Diagnostic and Interventional Radiology, Heidelberg University Hospital, Im Neuenheimer Feld 420, 69120 Heidelberg, Germany.,Translational Lung Research Center (TLRC), German Center for Lung Research (DZL), University of Heidelberg, Heidelberg, Germany
| | - Katharina Hellbach
- Department of Diagnostic and Interventional Radiology, Heidelberg University Hospital, Im Neuenheimer Feld 420, 69120 Heidelberg, Germany.,Diagnostic and Interventional Radiology with Nuclear Medicine, Thoraxklinik at University Hospital Heidelberg, Heidelberg, Germany.,Translational Lung Research Center (TLRC), German Center for Lung Research (DZL), University of Heidelberg, Heidelberg, Germany
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15
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Alexander BD, Lamoth F, Heussel CP, Prokop CS, Desai SR, Morrissey CO, Baddley JW. Guidance on Imaging for Invasive Pulmonary Aspergillosis and Mucormycosis: From the Imaging Working Group for the Revision and Update of the Consensus Definitions of Fungal Disease from the EORTC/MSGERC. Clin Infect Dis 2021; 72:S79-S88. [PMID: 33709131 DOI: 10.1093/cid/ciaa1855] [Citation(s) in RCA: 40] [Impact Index Per Article: 13.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022] Open
Abstract
BACKGROUND Clinical imaging in suspected invasive fungal disease (IFD) has a significant role in early detection of disease and helps direct further testing and treatment. Revised definitions of IFD from the EORTC/MSGERC were recently published and provide clarity on the role of imaging for the definition of IFD. Here, we provide evidence to support these revised diagnostic guidelines. METHODS We reviewed data on imaging modalities and techniques used to characterize IFDs. RESULTS Volumetric high-resolution computed tomography (CT) is the method of choice for lung imaging. Although no CT radiologic pattern is pathognomonic of IFD, the halo sign, in the appropriate clinical setting, is highly suggestive of invasive pulmonary aspergillosis (IPA) and associated with specific stages of the disease. The ACS is not specific for IFD and occurs in the later stages of infection. By contrast, the reversed halo sign and the hypodense sign are typical of pulmonary mucormycosis but occur less frequently. In noncancer populations, both invasive pulmonary aspergillosis and mucormycosis are associated with "atypical" nonnodular presentations, including consolidation and ground-glass opacities. CONCLUSIONS A uniform definition of IFD could improve the quality of clinical studies and aid in differentiating IFD from other pathology in clinical practice. Radiologic assessment of the lung is an important component of the diagnostic work-up and management of IFD. Periodic review of imaging studies that characterize findings in patients with IFD will inform future diagnostic guidelines.
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Affiliation(s)
- Barbara D Alexander
- Department of Medicine, Division of Infectious Diseases, Duke University, Durham, North Carolina, USA
| | - Frédéric Lamoth
- Service of Infectious Diseases, Department of Medicine, Lausanne University Hospital and University of Lausanne, Lausanne, Switzerland.,Institute of Microbiology, Lausanne University Hospital and University of Lausanne, Lausanne, Switzerland
| | - Claus Peter Heussel
- Department of Diagnostic and Interventional Radiology with Nuclear Medicine, Thoraxklinik gGmbH, Heidelberg, Germany.,Translational Lung Research Centre Heidelberg, Member of the German Centre for Lung Research.,Diagnostic and Interventional Radiology, Ruprecht-Karls-University, Heidelberg, Germany
| | | | - Sujal R Desai
- Department of Radiology, Royal Brompton and Harefield National Health Service Foundation Trust, London and National Heart and Lung Institute, Imperial College, London, United Kingdom
| | - C Orla Morrissey
- Department of Infectious Diseases, Alfred Health and Monash University, Melbourne, Australia
| | - John W Baddley
- Division of Infectious Diseases, University of Maryland School of Medicine, Baltimore, Maryland, USA
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16
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Ley-Zaporozhan J, Giannakis A, Norajitra T, Weinheimer O, Kehler L, Dinkel J, Ganter C, Ley S, Van Lunteren C, Eichinger M, Heussel G, Kauczor HU, Maier-Hein KH, Kreuter M, Heussel CP. Fully Automated Segmentation of Pulmonary Fibrosis Using Different Software Tools. Respiration 2021; 100:580-587. [PMID: 33857945 DOI: 10.1159/000515182] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2020] [Accepted: 02/07/2021] [Indexed: 11/19/2022] Open
Abstract
OBJECTIVE Evaluation of software tools for segmentation, quantification, and characterization of fibrotic pulmonary parenchyma changes will strengthen the role of CT as biomarkers of disease extent, evolution, and response to therapy in idiopathic pulmonary fibrosis (IPF) patients. METHODS 418 nonenhanced thin-section MDCTs of 127 IPF patients and 78 MDCTs of 78 healthy individuals were analyzed through 3 fully automated, completely different software tools: YACTA, LUFIT, and IMBIO. The agreement between YACTA and LUFIT on segmented lung volume and 80th (reflecting fibrosis) and 40th (reflecting ground-glass opacity) percentile of the lung density histogram was analyzed using Bland-Altman plots. The fibrosis and ground-glass opacity segmented by IMBIO (lung texture analysis software tool) were included in specific regression analyses. RESULTS In the IPF-group, LUFIT outperformed YACTA by segmenting more lung volume (mean difference 242 mL, 95% limits of agreement -54 to 539 mL), as well as quantifying higher 80th (76 HU, -6 to 158 HU) and 40th percentiles (9 HU, -73 to 90 HU). No relevant differences were revealed in the control group. The 80th/40th percentile as quantified by LUFIT correlated positively with the percentage of fibrosis/ground-glass opacity calculated by IMBIO (r = 0.78/r = 0.92). CONCLUSIONS In terms of segmentation of pulmonary fibrosis, LUFIT as a shape model-based segmentation software tool is superior to the threshold-based YACTA, tool, since the density of (severe) fibrosis is similar to that of the surrounding soft tissues. Therefore, shape modeling as used in LUFIT may serve as a valid tool in the quantification of IPF, since this mainly affects the subpleural space.
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Affiliation(s)
- Julia Ley-Zaporozhan
- Department Radiology, University Hospital, LMU Munich, Munich, Germany.,Comprehensive Pneumology Center (CPC), Member of the German Center of Lung Research (DZL), Munich, Germany
| | - Athanasios Giannakis
- Center for Interstitial and Rare Lung Diseases, Thoraxklinik at University of Heidelberg, Heidelberg, Germany.,Diagnostic and Interventional Radiology with Nuclear Medicine, Thoraxklinik at University of Heidelberg, Heidelberg, Germany.,Translational Lung Research Center (TLRC), Member of the German Center for Lung Research (DZL), University of Heidelberg, Heidelberg, Germany
| | - Tobias Norajitra
- Division of Medical and Biological Informatics (E130), German Cancer Research Center (DFKZ), Heidelberg, Germany
| | - Oliver Weinheimer
- Translational Lung Research Center (TLRC), Member of the German Center for Lung Research (DZL), University of Heidelberg, Heidelberg, Germany.,Diagnostic and Interventional Radiology, University Hospital Heidelberg, Heidelberg, Germany
| | - Lars Kehler
- Center for Interstitial and Rare Lung Diseases, Thoraxklinik at University of Heidelberg, Heidelberg, Germany.,Pneumology and Respiratory Critical Care Medicine, Thoraxklinik at University of Heidelberg, Heidelberg, Germany
| | - Julien Dinkel
- Department Radiology, University Hospital, LMU Munich, Munich, Germany.,Comprehensive Pneumology Center (CPC), Member of the German Center of Lung Research (DZL), Munich, Germany
| | - Claudia Ganter
- Center for Interstitial and Rare Lung Diseases, Thoraxklinik at University of Heidelberg, Heidelberg, Germany.,Translational Lung Research Center (TLRC), Member of the German Center for Lung Research (DZL), University of Heidelberg, Heidelberg, Germany.,Pneumology and Respiratory Critical Care Medicine, Thoraxklinik at University of Heidelberg, Heidelberg, Germany
| | - Sebastian Ley
- Department Radiology, University Hospital, LMU Munich, Munich, Germany.,Diagnostische und Interventionelle Radiologie, Artemed Klinikum München Süd, Munich, Germany
| | - Csilla Van Lunteren
- Biometrie des Instituts für Medizinische Biometrie und Informatik (IMBI), Heidelberg, Germany
| | - Monika Eichinger
- Center for Interstitial and Rare Lung Diseases, Thoraxklinik at University of Heidelberg, Heidelberg, Germany.,Diagnostic and Interventional Radiology with Nuclear Medicine, Thoraxklinik at University of Heidelberg, Heidelberg, Germany.,Translational Lung Research Center (TLRC), Member of the German Center for Lung Research (DZL), University of Heidelberg, Heidelberg, Germany
| | - Gudula Heussel
- Diagnostic and Interventional Radiology with Nuclear Medicine, Thoraxklinik at University of Heidelberg, Heidelberg, Germany.,Translational Lung Research Center (TLRC), Member of the German Center for Lung Research (DZL), University of Heidelberg, Heidelberg, Germany
| | - Hans-Ulrich Kauczor
- Translational Lung Research Center (TLRC), Member of the German Center for Lung Research (DZL), University of Heidelberg, Heidelberg, Germany.,Diagnostic and Interventional Radiology, University Hospital Heidelberg, Heidelberg, Germany
| | - Klaus H Maier-Hein
- Division of Medical and Biological Informatics (E130), German Cancer Research Center (DFKZ), Heidelberg, Germany
| | - Michael Kreuter
- Center for Interstitial and Rare Lung Diseases, Thoraxklinik at University of Heidelberg, Heidelberg, Germany.,Translational Lung Research Center (TLRC), Member of the German Center for Lung Research (DZL), University of Heidelberg, Heidelberg, Germany.,Pneumology and Respiratory Critical Care Medicine, Thoraxklinik at University of Heidelberg, Heidelberg, Germany
| | - Claus Peter Heussel
- Diagnostic and Interventional Radiology with Nuclear Medicine, Thoraxklinik at University of Heidelberg, Heidelberg, Germany.,Translational Lung Research Center (TLRC), Member of the German Center for Lung Research (DZL), University of Heidelberg, Heidelberg, Germany.,Diagnostic and Interventional Radiology, University Hospital Heidelberg, Heidelberg, Germany
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17
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Kreuter M, Müller-Ladner U, Costabel U, Jonigk D, Peter Heussel C. The Diagnosis and Treatment of Pulmonary Fibrosis. Dtsch Arztebl Int 2021; 118:arztebl.m2021.0018. [PMID: 33531115 PMCID: PMC8212400 DOI: 10.3238/arztebl.m2021.0018] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/03/2020] [Accepted: 10/14/2020] [Indexed: 02/01/2023]
Abstract
BACKGROUND The different types of pulmonary fibrosis are a subgroup of the interstitial lung diseases (ILDs). They are associated with a chronic and often progressive course. METHODS This review is based on pertinent publications retrieved by a selective search in the EMBASE and PubMed databases, with an emphasis on articles published from 2000 to 2020. RESULTS The most common type of pulmonary fibrosis is idiopathic pulmonary fibrosis (IPF). Among other relevant types, the most important ones are fibrosing hypersensitivity pneumonitis (fHP) and ILDs associated with systemic diseases, all of which are rare and generally carry a poor prognosis. The essential prerequisite to accurate diagnosis is aninterdisciplinary approach, taking account of the clinical, histological, and radiological aspects. The main complications of pulmonary fibrosis are acute exacerbations and pulmonary hypertension; comorbidities are also of prognostic relevance. Treatment of pulmonary fibrosis depends on the subtype and clinical behavior. For IPF, antifibrotic therapy is indicated; fHP, on the other hand, is mainly treated by antigen avoidance and immune modulation. The predominant mode of treatment for systemic disease-associated pulmonary fibrosis is immune suppression. Antifibrotic agents can also be useful in the treatment of other types of progressivepulmonary fibrosis besides IPF. CONCLUSION The differential diagnosis of pulmonary fibrosis, though complex, is clinically essential, as different types of pulmonary fibrosis are treated differently.
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Affiliation(s)
- Michael Kreuter
- Center for Interstitial and Rare Lung Diseases, Pneumology and Respiratory Critical Care Medicine, Thoraxklinik at Heidelberg University Hospital
- German Center for Lung Research (DZL)
| | - Ulf Müller-Ladner
- Department of Internal Medicine and Rheumatology, Campus Kerckhoff, Justus-Liebig-University Giessen, Bad Nauheim
| | - Ulrich Costabel
- Department of Pneumology, Ruhrlandklinik, University Medical Center Essen
| | - Danny Jonigk
- German Center for Lung Research (DZL)
- Institute of Pathology, Hannover Medical School
| | - Claus Peter Heussel
- German Center for Lung Research (DZL)
- Department of Diagnostic and Interventional Radiology, Thoraxklinik at Heidelberg University Hospital
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18
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Heuvelmans MA, van Ooijen PMA, Ather S, Silva CF, Han D, Heussel CP, Hickes W, Kauczor HU, Novotny P, Peschl H, Rook M, Rubtsov R, von Stackelberg O, Tsakok MT, Arteta C, Declerck J, Kadir T, Pickup L, Gleeson F, Oudkerk M. Lung cancer prediction by Deep Learning to identify benign lung nodules. Lung Cancer 2021; 154:1-4. [PMID: 33556604 DOI: 10.1016/j.lungcan.2021.01.027] [Citation(s) in RCA: 30] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2020] [Revised: 01/22/2021] [Accepted: 01/25/2021] [Indexed: 02/03/2023]
Abstract
INTRODUCTION Deep Learning has been proposed as promising tool to classify malignant nodules. Our aim was to retrospectively validate our Lung Cancer Prediction Convolutional Neural Network (LCP-CNN), which was trained on US screening data, on an independent dataset of indeterminate nodules in an European multicentre trial, to rule out benign nodules maintaining a high lung cancer sensitivity. METHODS The LCP-CNN has been trained to generate a malignancy score for each nodule using CT data from the U.S. National Lung Screening Trial (NLST), and validated on CT scans containing 2106 nodules (205 lung cancers) detected in patients from from the Early Lung Cancer Diagnosis Using Artificial Intelligence and Big Data (LUCINDA) study, recruited from three tertiary referral centers in the UK, Germany and Netherlands. We pre-defined a benign nodule rule-out test, to identify benign nodules whilst maintaining a high sensitivity, by calculating thresholds on the malignancy score that achieve at least 99 % sensitivity on the NLST data. Overall performance per validation site was evaluated using Area-Under-the-ROC-Curve analysis (AUC). RESULTS The overall AUC across the European centers was 94.5 % (95 %CI 92.6-96.1). With a high sensitivity of 99.0 %, malignancy could be ruled out in 22.1 % of the nodules, enabling 18.5 % of the patients to avoid follow-up scans. The two false-negative results both represented small typical carcinoids. CONCLUSION The LCP-CNN, trained on participants with lung nodules from the US NLST dataset, showed excellent performance on identification of benign lung nodules in a multi-center external dataset, ruling out malignancy with high accuracy in about one fifth of the patients with 5-15 mm nodules.
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Affiliation(s)
- Marjolein A Heuvelmans
- University of Groningen, University Medical Center Groningen Groningen, Department of Epidemiology, Groningen, The Netherlands; Department of Pulmonary Medicine, Medisch Spectrum Twente, Enschede, The Netherlands.
| | - Peter M A van Ooijen
- University of Groningen, University Medical Center Groningen Groningen, Department of Radiation Oncology, Groningen, The Netherlands.
| | - Sarim Ather
- Department of Radiology, Churchill Hospital, Oxford University Hospitals NHS Foundation Trust, Oxford, United Kingdom.
| | - Carlos Francisco Silva
- Diagnostic and Interventional Radiology, University Hospital Heidelberg, Heidelberg, Germany; Translational Lung Research Center, Member of the German Lung Research Center, Heidelberg, Germany; Department of Diagnostic and Interventional Radiology With Nuclear Medicine, Thoraxklinik, Heidelberg University Hospital, Heidelberg, Germany.
| | - Daiwei Han
- University of Groningen, University Medical Center Groningen Groningen, Department of Radiology, Groningen, The Netherlands.
| | - Claus Peter Heussel
- Diagnostic and Interventional Radiology, University Hospital Heidelberg, Heidelberg, Germany; Translational Lung Research Center, Member of the German Lung Research Center, Heidelberg, Germany; Department of Diagnostic and Interventional Radiology With Nuclear Medicine, Thoraxklinik, Heidelberg University Hospital, Heidelberg, Germany.
| | - William Hickes
- Oxford University Hospitals NHS Foundation Trust, United Kingdom.
| | - Hans-Ulrich Kauczor
- Diagnostic and Interventional Radiology, University Hospital Heidelberg, Heidelberg, Germany; Translational Lung Research Center, Member of the German Lung Research Center, Heidelberg, Germany; Department of Diagnostic and Interventional Radiology With Nuclear Medicine, Thoraxklinik, Heidelberg University Hospital, Heidelberg, Germany.
| | - Petr Novotny
- Optellum Ltd., Oxford, United Kingdom; Department of Respiratory Sciences, College of Life Sciences, University of Leicester, Leicester, United Kingdom.
| | - Heiko Peschl
- Department of Radiology, Oxford University Hospitals NHS Foundation Trust, Oxford, UK.
| | - Mieneke Rook
- University of Groningen, University Medical Center Groningen Groningen, Department of Radiology, Groningen, The Netherlands; Martini Hospital Groningen, Department of Radiology, Groningen, The Netherlands.
| | - Roman Rubtsov
- Diagnostic and Interventional Radiology, University Hospital Heidelberg, Heidelberg, Germany; Translational Lung Research Center, Member of the German Lung Research Center, Heidelberg, Germany; Department of Diagnostic and Interventional Radiology With Nuclear Medicine, Thoraxklinik, Heidelberg University Hospital, Heidelberg, Germany.
| | - Oyunbileg von Stackelberg
- Diagnostic and Interventional Radiology, University Hospital Heidelberg, Heidelberg, Germany; Translational Lung Research Center, Member of the German Lung Research Center, Heidelberg, Germany; Department of Diagnostic and Interventional Radiology With Nuclear Medicine, Thoraxklinik, Heidelberg University Hospital, Heidelberg, Germany.
| | - Maria T Tsakok
- Department of Radiology, Oxford University Hospitals NHS Foundation Trust, Oxford, UK.
| | | | | | | | | | - Fergus Gleeson
- Oxford University Hospitals NHS Foundation Trust, United Kingdom.
| | - Matthijs Oudkerk
- University of Groningen, Faculty of Medical Sciences, Groningen, The Netherlands.
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19
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Eichkorn T, Bozorgmehr F, Regnery S, Dinges LA, Kudak A, Bougatf N, Weber D, Christopoulos P, Muley T, Kobinger S, König L, Hörner-Rieber J, Adeberg S, Heussel CP, Thomas M, Debus J, El Shafie RA. Consolidation Immunotherapy After Platinum-Based Chemoradiotherapy in Patients With Unresectable Stage III Non-Small Cell Lung Cancer-Cross-Sectional Study of Eligibility and Administration Rates. Front Oncol 2020; 10:586449. [PMID: 33335856 PMCID: PMC7736629 DOI: 10.3389/fonc.2020.586449] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2020] [Accepted: 10/23/2020] [Indexed: 12/25/2022] Open
Abstract
Introduction The PACIFC trial demonstrated a significant benefit of durvalumab consolidation immunotherapy (CIT) after definitive platinum-based chemoradiotherapy (P-CRT) for survival in stage III non-small cell lung cancer (NSCLC). It is unknown how many patients are eligible in clinical practice to receive CIT according to PACIFIC criteria compared to real administration rates and what influencing factors are. Patients and Methods We analyzed 442 patients with unresectable stage III NSCLC who received P-CRT between 2009 and 2019 regarding CIT eligibility rates according to PACIFIC criteria and administration rates since drug approval. Results Sixty-four percent of 437 patients were male, median age was 63 years [interquartile range (IQR): 57–69]. The most common histologic subtypes were adenocarcinoma (42.8%) and squamous cell carcinoma (41.1%), most tumors were in stage IIIB (56.8%). Mean PD-L1 tumor proportion score (TPS) was 29.8% (IQR: 1–60). The median total RT dose was 60 Gy (IQR: 60–66). Platinum component of P-CRT was evenly distributed between cisplatin (51.4%) and carboplatin (48.6%). 50.3% of patients were eligible for CIT according to PACIFIC criteria. Observed contraindications were progressive disease according to RECIST (32.4%), followed by a PD-L1 TPS < 1% (22.3%), pneumonitis CTCAE ≥ 2 (12.6%) and others (4.9%). One year after drug approval, 85.6% of patients who were eligible according to PACIFIC criteria actually received CIT. Time interval between chemotherapy start and radiation therapy start (OR 0.9, 95% CI: [0.9; 1.0] p = 0.009) and probably cisplatin as platinum-component of P-CRT (OR 1.5, 95% CI: [1.0; 2.4] p < 0.061) influence CIT eligibility. Highly positive PD-L1 TPS (≥50%; (OR 2.4, 95% CI: [1.3; 4.5] p = 0.004) was associated to a better chance for CIT eligibility. Conclusion Eighty-five percent of potentially eligible patients received CIT one year after drug approval. Fifty percent of patients did not meet PACIFIC criteria for durvalumab eligibility, this was mainly caused by disease progression during platinum-based CRT, followed by therapy-related pneumonitis and PD-L1 TPS < 1% (in view of the EMA drug approval).
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Affiliation(s)
- Tanja Eichkorn
- Department of Radiation Oncology, Heidelberg University Hospital, Heidelberg, Germany.,National Center for Radiation Oncology (NCRO), Heidelberg Institute for Radiation Oncology (HIRO), Heidelberg, Germany
| | - Farastuk Bozorgmehr
- National Center for Tumor Diseases (NCT), Heidelberg University Hospital, Heidelberg, Germany.,Thoracic Clinic, Heidelberg University, Heidelberg, Germany
| | - Sebastian Regnery
- Department of Radiation Oncology, Heidelberg University Hospital, Heidelberg, Germany.,National Center for Radiation Oncology (NCRO), Heidelberg Institute for Radiation Oncology (HIRO), Heidelberg, Germany
| | - Lisa A Dinges
- Department of Radiation Oncology, Heidelberg University Hospital, Heidelberg, Germany.,National Center for Radiation Oncology (NCRO), Heidelberg Institute for Radiation Oncology (HIRO), Heidelberg, Germany
| | - Andreas Kudak
- Department of Radiation Oncology, Heidelberg University Hospital, Heidelberg, Germany.,National Center for Radiation Oncology (NCRO), Heidelberg Institute for Radiation Oncology (HIRO), Heidelberg, Germany.,Clinical Cooperation Unit Radiation Oncology (E050), German Cancer Research Center (DKFZ), Heidelberg, Germany
| | - Nina Bougatf
- Department of Radiation Oncology, Heidelberg University Hospital, Heidelberg, Germany.,National Center for Radiation Oncology (NCRO), Heidelberg Institute for Radiation Oncology (HIRO), Heidelberg, Germany.,National Center for Tumor Diseases (NCT), Heidelberg University Hospital, Heidelberg, Germany.,Clinical Cooperation Unit Radiation Oncology (E050), German Cancer Research Center (DKFZ), Heidelberg, Germany
| | - Dorothea Weber
- Institute for Medical Biometrics and Informatics, Heidelberg University, Heidelberg, Germany
| | - Petros Christopoulos
- National Center for Tumor Diseases (NCT), Heidelberg University Hospital, Heidelberg, Germany.,Thoracic Clinic, Heidelberg University, Heidelberg, Germany.,Translational Lung Research Center Heidelberg (TLRC-H, German Center for Lung Research (DZL), Heidelberg, Germany
| | - Thomas Muley
- National Center for Tumor Diseases (NCT), Heidelberg University Hospital, Heidelberg, Germany.,Thoracic Clinic, Heidelberg University, Heidelberg, Germany.,Translational Lung Research Center Heidelberg (TLRC-H, German Center for Lung Research (DZL), Heidelberg, Germany
| | - Sonja Kobinger
- National Center for Tumor Diseases (NCT), Heidelberg University Hospital, Heidelberg, Germany.,Thoracic Clinic, Heidelberg University, Heidelberg, Germany.,Translational Lung Research Center Heidelberg (TLRC-H, German Center for Lung Research (DZL), Heidelberg, Germany
| | - Laila König
- Department of Radiation Oncology, Heidelberg University Hospital, Heidelberg, Germany.,National Center for Radiation Oncology (NCRO), Heidelberg Institute for Radiation Oncology (HIRO), Heidelberg, Germany
| | - Juliane Hörner-Rieber
- Department of Radiation Oncology, Heidelberg University Hospital, Heidelberg, Germany.,National Center for Radiation Oncology (NCRO), Heidelberg Institute for Radiation Oncology (HIRO), Heidelberg, Germany.,Clinical Cooperation Unit Radiation Oncology (E050), German Cancer Research Center (DKFZ), Heidelberg, Germany
| | - Sebastian Adeberg
- Department of Radiation Oncology, Heidelberg University Hospital, Heidelberg, Germany.,National Center for Radiation Oncology (NCRO), Heidelberg Institute for Radiation Oncology (HIRO), Heidelberg, Germany
| | - Claus Peter Heussel
- National Center for Tumor Diseases (NCT), Heidelberg University Hospital, Heidelberg, Germany.,Translational Lung Research Center Heidelberg (TLRC-H, German Center for Lung Research (DZL), Heidelberg, Germany.,Department of Diagnostic and Interventional Radiology, Thoracic Clinic, Heidelberg University, Heidelberg, Germany.,Department of Diagnostic and Interventional Radiology with Nuclear Medicine, Thoracic Clinic, Heidelberg University, Heidelberg, Germany
| | - Michael Thomas
- National Center for Tumor Diseases (NCT), Heidelberg University Hospital, Heidelberg, Germany.,Thoracic Clinic, Heidelberg University, Heidelberg, Germany.,Translational Lung Research Center Heidelberg (TLRC-H, German Center for Lung Research (DZL), Heidelberg, Germany
| | - Jürgen Debus
- Department of Radiation Oncology, Heidelberg University Hospital, Heidelberg, Germany.,National Center for Radiation Oncology (NCRO), Heidelberg Institute for Radiation Oncology (HIRO), Heidelberg, Germany.,National Center for Tumor Diseases (NCT), Heidelberg University Hospital, Heidelberg, Germany.,Clinical Cooperation Unit Radiation Oncology (E050), German Cancer Research Center (DKFZ), Heidelberg, Germany.,German Cancer Consortium (DKTK), Partner Site Heidelberg, German Cancer Research Center (DKFZ), Heidelberg, Germany
| | - Rami A El Shafie
- Department of Radiation Oncology, Heidelberg University Hospital, Heidelberg, Germany.,National Center for Radiation Oncology (NCRO), Heidelberg Institute for Radiation Oncology (HIRO), Heidelberg, Germany
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20
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Matsumoto S, Fukuma S, Shinya T, Kitayama T, Kajita S, Masaoka Y, Hashimura S, Heussel CP, Kauczor HU, Kanazawa S. Gradual enhancement pattern of tracheobronchial adenoid cystic carcinoma on multiphasic dynamic computed tomography : a case series. J Med Invest 2020; 67:378-381. [PMID: 33148922 DOI: 10.2152/jmi.67.378] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
Tracheobronchial adenoid cystic carcinoma is a rare malignancy. To the best of our knowledge, its enhancement pattern on multiphasic contrast-enhanced multidetector computed tomography has not been reported. Herein, we report the computed tomography findings of three consecutive cases of tracheobronchial adenoid cystic carcinoma. All lesions presented a gradual enhancement pattern on multiphasic contrast-enhanced computed tomography. We speculate that the gradual enhancement pattern on multiphasic contrast-enhanced computed tomography could potentially serve as a characteristic imaging feature and may therefore be a clue to diagnose tracheobronchial adenoid cystic carcinoma. J. Med. Invest. 67 : 378-381, August, 2020.
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Affiliation(s)
- Shinsaku Matsumoto
- Department of Diagnostic Radiology, Saiseikai Yokohamashi Tobu Hospital, 3-6-1 Shimosueyoshi, Tsurumi-ku, Yokohama City, Kanagawa, 230-0012, Japan.,Department of Diagnostic Radiology, Keio University School of Medicine, 35 Shinanomachi, Shinjuku-ku, Tokyo, 160-8582, Japan
| | - Shogo Fukuma
- Department of Radiology, Okayama University Hospital, 2-5-1, Shikata-cho, Kita-ku, Okayama City, Okayama, 700-8558, Japan
| | - Takayoshi Shinya
- Department of Diagnostic and Therapeutic Radiology, Kawasaki Medical School General Medical Center, 2-6-2 Nakasange, Kita-ku, Okayama City, Okayama, 700-8505, Japan.,Department of Diagnostic and Interventional Radiology, University of Heidelberg, Germany, Im Neuenheimer Feld 110, Heidelberg, 69120, Germany.,Department of Diagnostic and Interventional Radiology with Nuclear Medicine, Thoraxklinik at University of Heidelberg, Röntgenstraße 1, Heidelberg, 69126, Germany
| | - Takahiro Kitayama
- Department of Radiology, Okayama University Hospital, 2-5-1, Shikata-cho, Kita-ku, Okayama City, Okayama, 700-8558, Japan
| | - Soichiro Kajita
- Department of Radiology, Okayama University Hospital, 2-5-1, Shikata-cho, Kita-ku, Okayama City, Okayama, 700-8558, Japan
| | - Yoshihisa Masaoka
- Department of Radiology, Okayama University Hospital, 2-5-1, Shikata-cho, Kita-ku, Okayama City, Okayama, 700-8558, Japan
| | - Shinji Hashimura
- Department of Radiology, Okayama Red Cross Hospital, 2-1-1 Aoe, Kita-ku, Okayama City, Okayama, 700-8607, Japan
| | - Claus Peter Heussel
- Department of Diagnostic and Interventional Radiology, University of Heidelberg, Germany, Im Neuenheimer Feld 110, Heidelberg, 69120, Germany.,Department of Diagnostic and Interventional Radiology with Nuclear Medicine, Thoraxklinik at University of Heidelberg, Röntgenstraße 1, Heidelberg, 69126, Germany.,Translational Lung Research Center Heidelberg (TLRC), Member of the German Center for Lung Research (DZL), Im Neuenheimer Feld 110, Heidelberg, 69120, Germany
| | - Hans-Ulrich Kauczor
- Department of Diagnostic and Interventional Radiology, University of Heidelberg, Germany, Im Neuenheimer Feld 110, Heidelberg, 69120, Germany.,Translational Lung Research Center Heidelberg (TLRC), Member of the German Center for Lung Research (DZL), Im Neuenheimer Feld 110, Heidelberg, 69120, Germany
| | - Susumu Kanazawa
- Department of Radiology, Okayama University Hospital, 2-5-1, Shikata-cho, Kita-ku, Okayama City, Okayama, 700-8558, Japan
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21
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Donnelly JP, Chen SC, Kauffman CA, Steinbach WJ, Baddley JW, Verweij PE, Clancy CJ, Wingard JR, Lockhart SR, Groll AH, Sorrell TC, Bassetti M, Akan H, Alexander BD, Andes D, Azoulay E, Bialek R, Bradsher RW, Bretagne S, Calandra T, Caliendo AM, Castagnola E, Cruciani M, Cuenca-Estrella M, Decker CF, Desai SR, Fisher B, Harrison T, Heussel CP, Jensen HE, Kibbler CC, Kontoyiannis DP, Kullberg BJ, Lagrou K, Lamoth F, Lehrnbecher T, Loeffler J, Lortholary O, Maertens J, Marchetti O, Marr KA, Masur H, Meis JF, Morrisey CO, Nucci M, Ostrosky-Zeichner L, Pagano L, Patterson TF, Perfect JR, Racil Z, Roilides E, Ruhnke M, Prokop CS, Shoham S, Slavin MA, Stevens DA, Thompson GR, Vazquez JA, Viscoli C, Walsh TJ, Warris A, Wheat LJ, White PL, Zaoutis TE, Pappas PG. Revision and Update of the Consensus Definitions of Invasive Fungal Disease From the European Organization for Research and Treatment of Cancer and the Mycoses Study Group Education and Research Consortium. Clin Infect Dis 2020; 71:1367-1376. [PMID: 31802125 PMCID: PMC7486838 DOI: 10.1093/cid/ciz1008] [Citation(s) in RCA: 1271] [Impact Index Per Article: 317.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2019] [Accepted: 10/08/2019] [Indexed: 12/13/2022] Open
Abstract
BACKGROUND Invasive fungal diseases (IFDs) remain important causes of morbidity and mortality. The consensus definitions of the Infectious Diseases Group of the European Organization for Research and Treatment of Cancer and the Mycoses Study Group have been of immense value to researchers who conduct clinical trials of antifungals, assess diagnostic tests, and undertake epidemiologic studies. However, their utility has not extended beyond patients with cancer or recipients of stem cell or solid organ transplants. With newer diagnostic techniques available, it was clear that an update of these definitions was essential. METHODS To achieve this, 10 working groups looked closely at imaging, laboratory diagnosis, and special populations at risk of IFD. A final version of the manuscript was agreed upon after the groups' findings were presented at a scientific symposium and after a 3-month period for public comment. There were several rounds of discussion before a final version of the manuscript was approved. RESULTS There is no change in the classifications of "proven," "probable," and "possible" IFD, although the definition of "probable" has been expanded and the scope of the category "possible" has been diminished. The category of proven IFD can apply to any patient, regardless of whether the patient is immunocompromised. The probable and possible categories are proposed for immunocompromised patients only, except for endemic mycoses. CONCLUSIONS These updated definitions of IFDs should prove applicable in clinical, diagnostic, and epidemiologic research of a broader range of patients at high-risk.
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Affiliation(s)
| | - Sharon C Chen
- Centre for Infectious Diseases and Microbiology, Laboratory Services, Institute of Clinical Pathology and Medical Research, Westmead Hospital, University of Sydney, Sydney, Australia
| | - Carol A Kauffman
- Division of Infectious Diseases, University of Michigan, VA Ann Arbor Healthcare System, Ann Arbor, Michigan, USA
| | - William J Steinbach
- Department of Pediatrics, Duke University Medical Center, Durham, North Carolina, USA
| | - John W Baddley
- Department of Medicine, Division of Infectious Diseases, University of Alabama at Birmingham, Birmingham, Alabama, USA
| | - Paul E Verweij
- Center of Expertise in Mycology Radboudumc/CWZ, Nijmegen, The Netherlands
| | | | - John R Wingard
- Department of Medicine, University of Florida College of Medicine, Gainesville, Florida, USA
| | - Shawn R Lockhart
- Mycotic Diseases Branch, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Andreas H Groll
- Infectious Disease Research Program, Center for Bone Marrow Transplantation and Department of Pediatric Hematology and Oncology University Children’s Hospital, Münster, Germany
| | - Tania C Sorrell
- University of Sydney, Marie Bashir Institute for Infectious Diseases & Biosecurity, University of Sydney School of Medicine Faculty of Medicine and Health, Westmead Institute for Centre for Infectious Diseases and Microbiology, Western Sydney Local Health District, Sydney, Australia
| | - Matteo Bassetti
- Infectious Disease Clinic, Department of Medicine University of Udine and Department of Health Sciences, DISSAL, University of Genoa, Genoa, Italy
| | - Hamdi Akan
- Ankara University, Faculty of Medicine, Cebeci Campus, Hematology Clinical Research Unit, Ankara, Turkey
| | - Barbara D Alexander
- Department of Medicine and Division of Infectious Diseases, Duke University Medical Center, Durham, North Carolina, USA
| | - David Andes
- Division of Infectious Diseases, Departments of Medicine, Microbiology and Immunology School of Medicine and Public Health and School of Pharmacy, University of Wisconsin, Madison, Wisconsin, USA
| | - Elie Azoulay
- Médicine Intensive et Réanimation Hôpital Saint-Louis, APHP, Université Paris Diderot, Paris, France
| | - Ralf Bialek
- Molecular Diagnostics of Infectious Diseases, Microbiology, LADR Zentrallabor Dr. Kramer & Kollegen, Geesthacht, Germany
| | - Robert W Bradsher
- Division of Infectious Diseases, University of Arkansas for Medical Sciences, Little Rock, Arkansas, USA
| | - Stephane Bretagne
- Institut Pasteur, Molecular Mycology Unit, CNRS UMR2000, Mycology Laboratory, Saint-Louis Hospital, Assistance Publique-Hôpitaux de Paris, Université de Paris, Paris, France
| | - Thierry Calandra
- Infectious Diseases Service, Department of Medicine, Lausanne University Hospital and University of Lausanne, Lausanne, Switzerland
| | - Angela M Caliendo
- Department of Medicine, Alpert Warren Medical School of Brown University, Providence, Rhode Island, USA
| | - Elio Castagnola
- Infectious Diseases Unit, IRCCS Istituto Giannina Gaslini, Genova, Italy
| | - Mario Cruciani
- Infectious Diseases Unit, G. Fracastoro Hospital, San Bonifacio, Verona, Italy
| | | | - Catherine F Decker
- Infectious Diseases Division, Department of Medicine, Uniformed Services University of the Health Sciences, Bethesda, Maryland, USA
| | - Sujal R Desai
- National Heart & Lung Institute, Imperial College London, the Royal Brompton & Harefield NHS Foundation Trust, London, UK
| | - Brian Fisher
- Pediatric Infectious Diseases Division at the Children’s Hospital of Philadelphia, Philadelphia, Pennsylvania, USA
| | - Thomas Harrison
- Centre for Global Health, Institute for Infection and Immunity, St Georges University of London, London, UK
| | - Claus Peter Heussel
- Diagnostic and Interventional Radiology, University Hospital Heidelberg, Translational Lung Research Center and Diagnostic and Interventional Radiology with Nuclear Medicine, Thoraxklinik Heidelberg, Heidelberg, Germany
| | - Henrik E Jensen
- Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
| | | | | | - Bart-Jan Kullberg
- Radboud Center for Infectious Diseases and Department of Medicine, Radboudumc, Nijmegen, The Netherlands
| | - Katrien Lagrou
- Department of Microbiology, Immunology and Transplantation and Department of Laboratory Medicine and National Reference Centre for Mycosis, University Hospitals Leuven, Leuven, Belgium
| | - Frédéric Lamoth
- Infectious Diseases Service, Department of Medicine and Institute of Microbiology, Lausanne University Hospital and University of Lausanne, Lausanne, Switzerland
| | - Thomas Lehrnbecher
- Pediatric Hematology and Oncology, Hospital for Children and Adolescents, University of Frankfurt, Frankfurt, Germany
| | - Jurgen Loeffler
- Molecular Biology and Infection, Medical Hospital II, WÜ4i, University Hospital Würzburg, Würzburg, Germany
| | - Olivier Lortholary
- Paris University, Necker Pasteur Center for Infectious Diseases and Tropical Medicine, IHU Imagine & Institut Pasteur, Molecular Mycology Unit, CNRS UMR 2000, Paris, France
| | - Johan Maertens
- Department of Hematology, University Hospitals Leuven, Leuven, Belgium
- Department of Microbiology, Immunology and Transplantation, K.U. Leuven, Leuven, Belgium
| | - Oscar Marchetti
- Infectious Diseases Service, Department of Medicine, Lausanne University Hospital and University of Lausanne, Lausanne, Switzerland
| | - Kieren A Marr
- Department of Medicine, Division of Infectious Diseases, Johns Hopkins University School
| | - Henry Masur
- Critical Care Medicine Department NIH-Clinical Center, Bethesda, Maryland, USA
| | - Jacques F Meis
- Department of Medical Microbiology and Infectious Diseases and Centre of Expertise in Mycology Radboudumc/Canisius Wilhelmina Hospital, Nijmegen, The Netherlands
| | | | - Marcio Nucci
- Department of Internal Medicine, Universidade Federal do Rio de Janeiro, Rio de Janeiro, Brazil
| | | | - Livio Pagano
- Istituto di Ematologia, Università Cattolica S. Cuore, Rome, Italy
| | - Thomas F Patterson
- UT Health San Antonio and South Texas Veterans Health Care System, San Antonio, Texas, USA
| | - John R Perfect
- Department of Medicine and Division of Infectious Diseases, Duke University Medical Center, Durham, North Carolina, USA
| | - Zdenek Racil
- Department of Internal Medicine–Hematology and Oncology, Masaryk University and University Hospital Brno, Brno, Czech Republic
| | - Emmanuel Roilides
- Infectious Diseases Unit, 3rd Department of Pediatrics, Faculty of Medicine, Aristotle University School of Health Sciences, Hippokration General Hospital, Thessaloniki, Greece
| | - Marcus Ruhnke
- Department of Hematology & Oncology, Lukas Hospital, Buende, Germany
| | - Cornelia Schaefer Prokop
- Meander Medical Center Amersfoort and Radiology, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Shmuel Shoham
- Department of Medicine, Division of Infectious Diseases, Johns Hopkins University School
| | - Monica A Slavin
- Department of Infectious Diseases, Peter MacCallum Cancer Center and the National Centre for Infections in Cancer, The University of Melbourne, Melbourne, Victoria, Australia
| | - David A Stevens
- Division of Infectious Diseases and Geographic Medicine, Stanford University Medical School, Stanford, California
- California Institute for Medical Research, San Jose, California, USA
| | - George R Thompson
- Department of Internal Medicine, Division of Infectious Diseases, University of California Davis Medical Center, Sacramento, California, USA
| | - Jose A Vazquez
- Division of Infectious Diseases, Medical College of Georgia/Augusta University, Augusta, Georgia, USA
| | - Claudio Viscoli
- Division of Infectious Disease, University of Genova and San Martino University Hospital, Genova, Italy
| | - Thomas J Walsh
- Weill Cornell Medicine of Cornell University, Departments of Medicine, Pediatrics, Microbiology & Immunology, New York, New York, USA
| | - Adilia Warris
- MRC Centre for Medical Mycology at the University of Aberdeen, Aberdeen, UK
| | | | - P Lewis White
- Public Health Wales Mycology Reference Laboratory, University Hospital of Wales, Heath Park, Cardiff, UK
| | - Theoklis E Zaoutis
- Perelman School of Medicine at the University of Pennsylvania, Children’s Hospital of Philadelphia and Roberts Center for Pediatric Research, Philadelphia, Pennsylvania, USA
| | - Peter G Pappas
- Department of Medicine, Division of Infectious Diseases, University of Alabama at Birmingham, Birmingham, Alabama, USA
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22
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Christopoulos P, Kirchner M, Roeper J, Saalfeld F, Janning M, Bozorgmehr F, Magios N, Kazdal D, Volckmar AL, Brückner LM, Bochtler T, Kriegsmann M, Endris V, Penzel R, Kriegsmann K, Eichhorn M, Herth FJF, Heussel CP, El Shafie RA, Schneider MA, Muley T, Meister M, Faehling M, Fischer JR, Heukamp L, Schirmacher P, Bischoff H, Wermke M, Loges S, Griesinger F, Stenzinger A, Thomas M. Risk stratification of EGFR + lung cancer diagnosed with panel-based next-generation sequencing. Lung Cancer 2020; 148:105-112. [PMID: 32871455 DOI: 10.1016/j.lungcan.2020.08.007] [Citation(s) in RCA: 22] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2020] [Revised: 07/24/2020] [Accepted: 08/04/2020] [Indexed: 02/07/2023]
Abstract
OBJECTIVE Panel-based next-generation sequencing (NGS) is increasingly used for the diagnosis of EGFR-mutated non-small-cell lung cancer (NSCLC) and could improve risk assessment in combination with clinical parameters. MATERIALS AND METHODS To this end, we retrospectively analyzed the outcome of 400 tyrosine kinase inhibitor (TKI)-treated EGFR+ NSCLC patients with validation of results in an independent cohort (n = 130). RESULTS EGFR alterations other than exon 19 deletions (non-del19), TP53 co-mutations, and brain metastases at baseline showed independent associations of similar strengths with progression-free (PFS hazard ratios [HR] 2.1-2.3) and overall survival (OS HR 1.7-2.2), in combination defining patient subgroups with distinct outcome (EGFR+NSCLC risk Score, "ENS", p < 0.001). Co-mutations beyond TP53 were rarely detected by our multigene panel (<5%) and not associated with clinical endpoints. Smoking did not affect outcome independently, but was associated with non-del19 EGFR mutations (p < 0.05) and comorbidities (p < 0.001). Laboratory parameters, like the blood lymphocyte-to-neutrophil ratio and serum LDH, correlated with the metastatic pattern (p < 0.01), but had no independent prognostic value. Reduced ECOG performance status (PS) was associated with comorbidities (p < 0.05) and shorter OS (p < 0.05), but preserved TKI efficacy. Non-adenocarcinoma histology was also associated with shorter OS (p < 0.05), but rare (2-3 %). The ECOG PS and non-adenocarcinoma histology could not be validated in our independent cohort, and did not increase the range of prognostication alongside the ENS. CONCLUSIONS EGFR variant, TP53 status and brain metastases predict TKI efficacy and survival in EGFR+ NSCLC irrespective of other currently available parameters ("ENS"). Together, they constitute a practical and reproducible approach for risk stratification of newly diagnosed metastatic EGFR+ NSCLC.
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Affiliation(s)
- P Christopoulos
- Department of Thoracic Oncology, Thoraxklinik at Heidelberg University Hospital, Heidelberg, Germany; Translational Lung Research Center Heidelberg (TLRC-H), Member of the German Center for Lung Research (DZL), Heidelberg, Germany
| | - M Kirchner
- Institute of Pathology, Heidelberg University Hospital, Heidelberg, Germany
| | - J Roeper
- Department of Hematology and Oncology, Pius-Hospital, University Dept. of Internal Medicine - Oncology, Oldenburg, Germany
| | - F Saalfeld
- Department of Thoracic Oncology, Carl-Gustav-Carus Dresden University Hospital, Dresden, Germany
| | - M Janning
- Department of Oncology, Hematology and Bone Marrow Transplantation with section Pneumology, Hubertus Wald Comprehensive Cancer Center Hamburg, University Medical Center Hamburg-Eppendorf, Hamburg, Germany; Division of Personalized Medical Oncology, German Cancer Research Center (DKFZ), Heidelberg, Germany; Department of Personalized Oncology, University Hospital Mannheim, Mannheim, Germany
| | - F Bozorgmehr
- Department of Thoracic Oncology, Thoraxklinik at Heidelberg University Hospital, Heidelberg, Germany; Translational Lung Research Center Heidelberg (TLRC-H), Member of the German Center for Lung Research (DZL), Heidelberg, Germany
| | - N Magios
- Department of Thoracic Oncology, Thoraxklinik at Heidelberg University Hospital, Heidelberg, Germany
| | - D Kazdal
- Institute of Pathology, Heidelberg University Hospital, Heidelberg, Germany; Translational Lung Research Center Heidelberg (TLRC-H), Member of the German Center for Lung Research (DZL), Heidelberg, Germany
| | - A L Volckmar
- Institute of Pathology, Heidelberg University Hospital, Heidelberg, Germany
| | - L M Brückner
- Department of Thoracic Oncology, Thoraxklinik at Heidelberg University Hospital, Heidelberg, Germany
| | - T Bochtler
- Department of Thoracic Oncology, Thoraxklinik at Heidelberg University Hospital, Heidelberg, Germany
| | - M Kriegsmann
- Institute of Pathology, Heidelberg University Hospital, Heidelberg, Germany; Translational Lung Research Center Heidelberg (TLRC-H), Member of the German Center for Lung Research (DZL), Heidelberg, Germany
| | - V Endris
- Institute of Pathology, Heidelberg University Hospital, Heidelberg, Germany
| | - R Penzel
- Institute of Pathology, Heidelberg University Hospital, Heidelberg, Germany
| | - K Kriegsmann
- Institute of Pathology, Heidelberg University Hospital, Heidelberg, Germany
| | - M Eichhorn
- Department of Thoracic Surgery, Thoraxklinik at Heidelberg University Hospital, Heidelberg, Germany; Translational Lung Research Center Heidelberg (TLRC-H), Member of the German Center for Lung Research (DZL), Heidelberg, Germany
| | - F J F Herth
- Department of Pulmonology, Thoraxklinik at Heidelberg University Hospital, Heidelberg, Germany; Translational Lung Research Center Heidelberg (TLRC-H), Member of the German Center for Lung Research (DZL), Heidelberg, Germany
| | - C P Heussel
- Diagnostic and Interventional Radiology With Nuclear Medicine, Thoraxklinik at Heidelberg University Hospital, Heidelberg, Germany; Translational Lung Research Center Heidelberg (TLRC-H), Member of the German Center for Lung Research (DZL), Heidelberg, Germany
| | - R A El Shafie
- Department of Radiation Oncology, Heidelberg University Hospital, Heidelberg, Germany
| | - M A Schneider
- Translational Research Unit, Thoraxklinik at Heidelberg University Hospital, Heidelberg, Germany; Translational Lung Research Center Heidelberg (TLRC-H), Member of the German Center for Lung Research (DZL), Heidelberg, Germany
| | - T Muley
- Translational Research Unit, Thoraxklinik at Heidelberg University Hospital, Heidelberg, Germany; Translational Lung Research Center Heidelberg (TLRC-H), Member of the German Center for Lung Research (DZL), Heidelberg, Germany
| | - M Meister
- Translational Research Unit, Thoraxklinik at Heidelberg University Hospital, Heidelberg, Germany; Translational Lung Research Center Heidelberg (TLRC-H), Member of the German Center for Lung Research (DZL), Heidelberg, Germany
| | - M Faehling
- Department of Pneumology, Esslingen Hospital, Esslingen, Germany
| | - J R Fischer
- Department of Thoracic Oncology, Lungenklinik Loewenstein, Loewenstein, Germany
| | - L Heukamp
- Institut Für Hämatopathologie Hamburg, Hamburg, Germany
| | - P Schirmacher
- Institute of Pathology, Heidelberg University Hospital, Heidelberg, Germany
| | - H Bischoff
- Department of Thoracic Oncology, Thoraxklinik at Heidelberg University Hospital, Heidelberg, Germany
| | - M Wermke
- Department of Thoracic Oncology, Carl-Gustav-Carus Dresden University Hospital, Dresden, Germany
| | - S Loges
- Department of Oncology, Hematology and Bone Marrow Transplantation with section Pneumology, Hubertus Wald Comprehensive Cancer Center Hamburg, University Medical Center Hamburg-Eppendorf, Hamburg, Germany; Division of Personalized Medical Oncology, German Cancer Research Center (DKFZ), Heidelberg, Germany; Department of Personalized Oncology, University Hospital Mannheim, Mannheim, Germany
| | - F Griesinger
- Department of Hematology and Oncology, Pius-Hospital, University Dept. of Internal Medicine - Oncology, Oldenburg, Germany
| | - A Stenzinger
- Institute of Pathology, Heidelberg University Hospital, Heidelberg, Germany; Translational Lung Research Center Heidelberg (TLRC-H), Member of the German Center for Lung Research (DZL), Heidelberg, Germany.
| | - M Thomas
- Department of Thoracic Oncology, Thoraxklinik at Heidelberg University Hospital, Heidelberg, Germany; Translational Lung Research Center Heidelberg (TLRC-H), Member of the German Center for Lung Research (DZL), Heidelberg, Germany.
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23
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Buzan MT, Wetscherek A, Rank CM, Kreuter M, Heussel CP, Kachelrieß M, Dinkel J. Delayed contrast dynamics as marker of regional impairment in pulmonary fibrosis using 5D MRI - a pilot study. Br J Radiol 2020; 93:20190121. [PMID: 32584606 DOI: 10.1259/bjr.20190121] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/11/2023] Open
Abstract
OBJECTIVE To analyse delayed contrast dynamics of fibrotic lesions in interstitial lung disease (ILD) using five dimensional (5D) MRI and to correlate contrast dynamics with disease severity. METHODS 20 patients (mean age: 71 years; M:F, 13:7), with chronic fibrosing ILD: n = 12 idiopathic pulmonary fibrosis (IPF) and n = 8 non-IPF, underwent thin-section multislice CT as part of the standard diagnostic workup and additionally MRI of the lung. 2 min after contrast injection, a radial gradient echo sequence with golden-angle spacing was acquired during 5 min of free-breathing, followed by 5D image reconstruction. Disease was categorized as severe or non-severe according to CT morphological regional severity. For each patient, 10 lesions were analysed. RESULTS IPF lesions showed later peak enhancement compared to non-IPF (severe: p = 0.01, non-severe: p = 0.003). Severe lesions showed later peak enhancement compared to non-severe lesions, in non-IPF (p = 0.04), but not in IPF (p = 0.35). There was a tendency towards higher accumulation and washout rates in IPF compared to non-IPF in non-severe disease. Severe lesions had lower washout rate than non-severe ones in both IPF (p = 0.003) and non-IPF (p = 0.005). Continuous contrast agent accumulation, without washout, was found only in IPF lesions. CONCLUSIONS Contrast agent dynamics are influenced by type and severity of pulmonary fibrosis, which might enable a more thorough characterisation of disease burden. The regional impairment is of particular interest in the context of antifibrotic treatments and was characterised using a non-invasive, non-irradiating, free-breathing method. ADVANCES IN KNOWLEDGE Delayed contrast enhancement patterns allow the assessment of regional lung impairment which could represent different disease stages or phenotypes in ILD.
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Affiliation(s)
- Maria Ta Buzan
- Department of Diagnostic and Interventional Radiology with Nuclear Medicine, Thoraxklinik at Heidelberg University Hospital, Heidelberg, Germany.,Department of Pneumology, Iuliu Hatieganu University of Medicine and Pharmacy, Cluj-Napoca, Romania.,Translational Lung Research Center Heidelberg (TLRC), Member of the German Center for Lung Research (DZL), Heidelberg, Germany.,Addenbrooke's Hospital, Cambridge University Hospitals NHS Foundation Trust, Cambridge, United Kingdom
| | - Andreas Wetscherek
- Medical Physics in Radiology, German Cancer Research Center (DKFZ), Heidelberg, Germany.,Joint Department of Physics at The Institute of Cancer Research and The Royal Marsden NHS Foundation Trust, London, United Kingdom
| | - Christopher M Rank
- Medical Physics in Radiology, German Cancer Research Center (DKFZ), Heidelberg, Germany
| | - Michael Kreuter
- Translational Lung Research Center Heidelberg (TLRC), Member of the German Center for Lung Research (DZL), Heidelberg, Germany.,Center for Rare and Interstitial Lung Diseases, Pneumology and respiratory critical care medicine, Thoraxklinik, Heidelberg University Hospital, Heidelberg, Germany
| | - Claus Peter Heussel
- Department of Diagnostic and Interventional Radiology with Nuclear Medicine, Thoraxklinik at Heidelberg University Hospital, Heidelberg, Germany.,Translational Lung Research Center Heidelberg (TLRC), Member of the German Center for Lung Research (DZL), Heidelberg, Germany.,Center for Rare and Interstitial Lung Diseases, Pneumology and respiratory critical care medicine, Thoraxklinik, Heidelberg University Hospital, Heidelberg, Germany
| | - Marc Kachelrieß
- Medical Physics in Radiology, German Cancer Research Center (DKFZ), Heidelberg, Germany
| | - Julien Dinkel
- Department of Diagnostic and Interventional Radiology with Nuclear Medicine, Thoraxklinik at Heidelberg University Hospital, Heidelberg, Germany.,Institute for Clinical Radiology, Ludwig-Maximilians-University Hospital Munich, Munich, Germany.,Comprehensive Pneumology Center Munich (CPC-M), Member of the German Center for Lung Research (DZL), Munich, Germany
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24
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Mathy RM, Kuhn TC, Kappes J, Wielpütz MO, Ruhparwar A, Frankenstein L, Tanner M, Geis N, Fischer C, Kasperk C, Heussel CP, Kreuter M, Wilkens FM. Intracardial PMMA bone cement embolism after kyphoplasty-an unusual cause for sudden chest pain, hemothorax and hemopericardium. Med Klin Intensivmed Notfmed 2020; 116:61-64. [PMID: 32607594 DOI: 10.1007/s00063-020-00698-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2019] [Revised: 07/08/2019] [Accepted: 08/10/2019] [Indexed: 10/24/2022]
Affiliation(s)
- R M Mathy
- Department of Diagnostic and Interventional Radiology, University of Heidelberg, Heidelberg, Germany
| | - T C Kuhn
- Department of Internal Medicine III, Division of Cardiology, University of Heidelberg, Heidelberg, Germany
| | - J Kappes
- Department of Pneumology and Respiratory Critical Care Medicine, Thoraxklinik, University of Heidelberg, Heidelberg, Germany
| | - M O Wielpütz
- Department of Diagnostic and Interventional Radiology, University of Heidelberg, Heidelberg, Germany.,Translational Lung Research Center Heidelberg (TLRC-H), German Center for Lung Research (DZL), Heidelberg, Germany
| | - A Ruhparwar
- Cardiac Surgery Clinic, University of Heidelberg, Heidelberg, Germany
| | - L Frankenstein
- Department of Internal Medicine III, Division of Cardiology, University of Heidelberg, Heidelberg, Germany
| | - M Tanner
- Heidelberg Trauma Research Group, Center for Orthopedics, Trauma Surgery and Spinal Cord Injury, Trauma and Reconstructive Surgery, University of Heidelberg, Heidelberg, Germany
| | - N Geis
- Department of Internal Medicine III, Division of Cardiology, University of Heidelberg, Heidelberg, Germany
| | - C Fischer
- Heidelberg Trauma Research Group, Center for Orthopedics, Trauma Surgery and Spinal Cord Injury, Trauma and Reconstructive Surgery, University of Heidelberg, Heidelberg, Germany
| | - C Kasperk
- Department of Medicine I and Clinical Chemistry, University of Heidelberg, Heidelberg, Germany
| | - C P Heussel
- Department of Diagnostic and Interventional Radiology, University of Heidelberg, Heidelberg, Germany.,Translational Lung Research Center Heidelberg (TLRC-H), German Center for Lung Research (DZL), Heidelberg, Germany.,Diagnostic and Interventional Radiology with Nuclear Medicine, Thoraxklinik, University of Heidelberg, Heidelberg, Germany
| | - M Kreuter
- Department of Pneumology and Respiratory Critical Care Medicine, Thoraxklinik, University of Heidelberg, Heidelberg, Germany.,Translational Lung Research Center Heidelberg (TLRC-H), German Center for Lung Research (DZL), Heidelberg, Germany
| | - F M Wilkens
- Department of Pneumology and Respiratory Critical Care Medicine, Thoraxklinik, University of Heidelberg, Heidelberg, Germany.
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25
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Wucherpfennig L, Kahn N, Preusch MR, Kriegsmann M, Heussel CP, Wielpütz MO, Kreuter M, Kriegsmann K, Eichinger M. [Fever, cough, limb pain - a trivial infection?]. Med Klin Intensivmed Notfmed 2020; 116:454-458. [PMID: 32588063 DOI: 10.1007/s00063-020-00701-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2020] [Revised: 05/07/2020] [Accepted: 05/08/2020] [Indexed: 10/24/2022]
Affiliation(s)
- L Wucherpfennig
- Klinik für Diagnostische und Interventionelle Radiologie, Universitätsklinikum Heidelberg, Im Neuenheimer Feld 110, 69120, Heidelberg, Deutschland. .,Translational Lung Research Center (TLRC) im Deutschen Zentrum für Lungenforschung (DZL), Heidelberg, Deutschland.
| | - N Kahn
- Translational Lung Research Center (TLRC) im Deutschen Zentrum für Lungenforschung (DZL), Heidelberg, Deutschland.,Zentrum für interstitielle und seltene Lungenerkrankungen, Pneumologie, Thoraxklinik, Universitätsklinik Heidelberg und Deutsches Zentrum für Lungenforschung, Heidelberg, Deutschland
| | - M R Preusch
- Innere Medizin III, Kardiologie, Angiologie, Pneumologie, Universitätsklinikum Heidelberg, Heidelberg, Deutschland
| | - M Kriegsmann
- Institut für Pathologie, Universitätsklinikum Heidelberg, Heidelberg, Deutschland
| | - C P Heussel
- Klinik für Diagnostische und Interventionelle Radiologie, Universitätsklinikum Heidelberg, Im Neuenheimer Feld 110, 69120, Heidelberg, Deutschland.,Translational Lung Research Center (TLRC) im Deutschen Zentrum für Lungenforschung (DZL), Heidelberg, Deutschland.,Diagnostische und Interventionelle Radiologie mit Nuklearmedizin, Universitätsklinikum Heidelberg, Heidelberg, Deutschland
| | - M O Wielpütz
- Klinik für Diagnostische und Interventionelle Radiologie, Universitätsklinikum Heidelberg, Im Neuenheimer Feld 110, 69120, Heidelberg, Deutschland.,Translational Lung Research Center (TLRC) im Deutschen Zentrum für Lungenforschung (DZL), Heidelberg, Deutschland.,Diagnostische und Interventionelle Radiologie mit Nuklearmedizin, Universitätsklinikum Heidelberg, Heidelberg, Deutschland
| | - M Kreuter
- Translational Lung Research Center (TLRC) im Deutschen Zentrum für Lungenforschung (DZL), Heidelberg, Deutschland.,Zentrum für interstitielle und seltene Lungenerkrankungen, Pneumologie, Thoraxklinik, Universitätsklinik Heidelberg und Deutsches Zentrum für Lungenforschung, Heidelberg, Deutschland
| | - K Kriegsmann
- Universitätsklinikum Heidelberg, Innere Medizin V, Hämatologie, Onkologie und Rheumatologie, Heidelberg, Deutschland
| | - M Eichinger
- Klinik für Diagnostische und Interventionelle Radiologie, Universitätsklinikum Heidelberg, Im Neuenheimer Feld 110, 69120, Heidelberg, Deutschland.,Translational Lung Research Center (TLRC) im Deutschen Zentrum für Lungenforschung (DZL), Heidelberg, Deutschland.,Diagnostische und Interventionelle Radiologie mit Nuklearmedizin, Universitätsklinikum Heidelberg, Heidelberg, Deutschland
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26
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Kriegsmann M, Haag C, Weis CA, Steinbuss G, Warth A, Zgorzelski C, Muley T, Winter H, Eichhorn ME, Eichhorn F, Kriegsmann J, Christopolous P, Thomas M, Witzens-Harig M, Sinn P, von Winterfeld M, Heussel CP, Herth FJF, Klauschen F, Stenzinger A, Kriegsmann K. Deep Learning for the Classification of Small-Cell and Non-Small-Cell Lung Cancer. Cancers (Basel) 2020; 12:cancers12061604. [PMID: 32560475 PMCID: PMC7352768 DOI: 10.3390/cancers12061604] [Citation(s) in RCA: 41] [Impact Index Per Article: 10.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2020] [Revised: 06/14/2020] [Accepted: 06/15/2020] [Indexed: 12/24/2022] Open
Abstract
Reliable entity subtyping is paramount for therapy stratification in lung cancer. Morphological evaluation remains the basis for entity subtyping and directs the application of additional methods such as immunohistochemistry (IHC). The decision of whether to perform IHC for subtyping is subjective, and access to IHC is not available worldwide. Thus, the application of additional methods to support morphological entity subtyping is desirable. Therefore, the ability of convolutional neuronal networks (CNNs) to classify the most common lung cancer subtypes, pulmonary adenocarcinoma (ADC), pulmonary squamous cell carcinoma (SqCC), and small-cell lung cancer (SCLC), was evaluated. A cohort of 80 ADC, 80 SqCC, 80 SCLC, and 30 skeletal muscle specimens was assembled; slides were scanned; tumor areas were annotated; image patches were extracted; and cases were randomly assigned to a training, validation or test set. Multiple CNN architectures (VGG16, InceptionV3, and InceptionResNetV2) were trained and optimized to classify the four entities. A quality control (QC) metric was established. An optimized InceptionV3 CNN architecture yielded the highest classification accuracy and was used for the classification of the test set. Image patch and patient-based CNN classification results were 95% and 100% in the test set after the application of strict QC. Misclassified cases mainly included ADC and SqCC. The QC metric identified cases that needed further IHC for definite entity subtyping. The study highlights the potential and limitations of CNN image classification models for tumor differentiation.
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Affiliation(s)
- Mark Kriegsmann
- Institute of Pathology, Heidelberg University, 69120 Heidelberg, Germany; (C.H.); (G.S.); (C.Z.); (P.S.); (M.v.W.); (A.S.)
- Translational Lung Research Centre Heidelberg, Member of the German Centre for Lung Research (DZL), 69120 Heidelberg, Germany; (T.M.); (H.W.); (M.E.E.); (F.E.); (P.C.); (M.T.); (C.P.H.); (F.J.F.H.)
- Correspondence: (M.K.); (K.K.); Tel.: +49-6221-56-36930 (M.K.); +49-6221-56-37238 (K.K.)
| | - Christian Haag
- Institute of Pathology, Heidelberg University, 69120 Heidelberg, Germany; (C.H.); (G.S.); (C.Z.); (P.S.); (M.v.W.); (A.S.)
- Department Hematology, Oncology and Rheumatology, Heidelberg University, 69120 Heidelberg, Germany
| | - Cleo-Aron Weis
- Institute of Pathology, University Medical Centre Mannheim, Heidelberg University, 68782 Mannheim, Germany;
| | - Georg Steinbuss
- Institute of Pathology, Heidelberg University, 69120 Heidelberg, Germany; (C.H.); (G.S.); (C.Z.); (P.S.); (M.v.W.); (A.S.)
- Department Hematology, Oncology and Rheumatology, Heidelberg University, 69120 Heidelberg, Germany
| | - Arne Warth
- Institute of Pathology, Cytopathology, and Molecular Pathology, UEGP MVZ Gießen/Wetzlar/Limburg, 65549 Limburg, Germany;
| | - Christiane Zgorzelski
- Institute of Pathology, Heidelberg University, 69120 Heidelberg, Germany; (C.H.); (G.S.); (C.Z.); (P.S.); (M.v.W.); (A.S.)
| | - Thomas Muley
- Translational Lung Research Centre Heidelberg, Member of the German Centre for Lung Research (DZL), 69120 Heidelberg, Germany; (T.M.); (H.W.); (M.E.E.); (F.E.); (P.C.); (M.T.); (C.P.H.); (F.J.F.H.)
- Department of Thoracic Surgery, Thoraxklinik, Heidelberg University, 69126 Heidelberg, Germany
| | - Hauke Winter
- Translational Lung Research Centre Heidelberg, Member of the German Centre for Lung Research (DZL), 69120 Heidelberg, Germany; (T.M.); (H.W.); (M.E.E.); (F.E.); (P.C.); (M.T.); (C.P.H.); (F.J.F.H.)
- Department of Thoracic Surgery, Thoraxklinik, Heidelberg University, 69126 Heidelberg, Germany
| | - Martin E. Eichhorn
- Translational Lung Research Centre Heidelberg, Member of the German Centre for Lung Research (DZL), 69120 Heidelberg, Germany; (T.M.); (H.W.); (M.E.E.); (F.E.); (P.C.); (M.T.); (C.P.H.); (F.J.F.H.)
- Department of Thoracic Surgery, Thoraxklinik, Heidelberg University, 69126 Heidelberg, Germany
| | - Florian Eichhorn
- Translational Lung Research Centre Heidelberg, Member of the German Centre for Lung Research (DZL), 69120 Heidelberg, Germany; (T.M.); (H.W.); (M.E.E.); (F.E.); (P.C.); (M.T.); (C.P.H.); (F.J.F.H.)
- Department of Thoracic Surgery, Thoraxklinik, Heidelberg University, 69126 Heidelberg, Germany
| | - Joerg Kriegsmann
- Molecular Pathology Trier, 54296 Trier, Germany;
- Danube Private University Krems, 3500 Krems, Austria
| | - Petros Christopolous
- Translational Lung Research Centre Heidelberg, Member of the German Centre for Lung Research (DZL), 69120 Heidelberg, Germany; (T.M.); (H.W.); (M.E.E.); (F.E.); (P.C.); (M.T.); (C.P.H.); (F.J.F.H.)
- Department of Thoracic Oncology, Thoraxklinik, Heidelberg University, 69126 Heidelberg, Germany
| | - Michael Thomas
- Translational Lung Research Centre Heidelberg, Member of the German Centre for Lung Research (DZL), 69120 Heidelberg, Germany; (T.M.); (H.W.); (M.E.E.); (F.E.); (P.C.); (M.T.); (C.P.H.); (F.J.F.H.)
- Department of Thoracic Oncology, Thoraxklinik, Heidelberg University, 69126 Heidelberg, Germany
| | | | - Peter Sinn
- Institute of Pathology, Heidelberg University, 69120 Heidelberg, Germany; (C.H.); (G.S.); (C.Z.); (P.S.); (M.v.W.); (A.S.)
| | - Moritz von Winterfeld
- Institute of Pathology, Heidelberg University, 69120 Heidelberg, Germany; (C.H.); (G.S.); (C.Z.); (P.S.); (M.v.W.); (A.S.)
| | - Claus Peter Heussel
- Translational Lung Research Centre Heidelberg, Member of the German Centre for Lung Research (DZL), 69120 Heidelberg, Germany; (T.M.); (H.W.); (M.E.E.); (F.E.); (P.C.); (M.T.); (C.P.H.); (F.J.F.H.)
- Department of Diagnostic and Interventional Radiology with Nuclear Medicine, Thoraxklinik, Heidelberg University, 69120 Heidelberg, Germany
- Department of Diagnostic and Interventional Radiology, Thoraxklinik, Heidelberg University, 69120 Heidelberg, Germany
| | - Felix J. F. Herth
- Translational Lung Research Centre Heidelberg, Member of the German Centre for Lung Research (DZL), 69120 Heidelberg, Germany; (T.M.); (H.W.); (M.E.E.); (F.E.); (P.C.); (M.T.); (C.P.H.); (F.J.F.H.)
- Department of Pneumology and Critical Care Medicine, Thoraxklinik, Heidelberg University, 69126 Heidelberg, Germany
| | | | - Albrecht Stenzinger
- Institute of Pathology, Heidelberg University, 69120 Heidelberg, Germany; (C.H.); (G.S.); (C.Z.); (P.S.); (M.v.W.); (A.S.)
- Translational Lung Research Centre Heidelberg, Member of the German Centre for Lung Research (DZL), 69120 Heidelberg, Germany; (T.M.); (H.W.); (M.E.E.); (F.E.); (P.C.); (M.T.); (C.P.H.); (F.J.F.H.)
| | - Katharina Kriegsmann
- Department Hematology, Oncology and Rheumatology, Heidelberg University, 69120 Heidelberg, Germany
- Correspondence: (M.K.); (K.K.); Tel.: +49-6221-56-36930 (M.K.); +49-6221-56-37238 (K.K.)
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27
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Brandelik SC, Heussel CP, Kauczor HU, Röcken C, Huber L, Basset M, Kimmich C, Schönland SO, Hegenbart U, Nattenmüller J. CT features in amyloidosis of the respiratory system - Comprehensive analysis in a tertiary referral center cohort. Eur J Radiol 2020; 129:109123. [PMID: 32590259 DOI: 10.1016/j.ejrad.2020.109123] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2019] [Revised: 06/04/2020] [Accepted: 06/07/2020] [Indexed: 12/27/2022]
Abstract
PURPOSE Amyloidosis of the respiratory system is rare and challenging since imaging findings have several more prevalent alternative diagnoses. We analyze and quantify chest CT findings in a large tertiary referral center patient cohort with confirmed amyloidosis of the respiratory system. METHODS 67 patients with histology-proven amyloidosis of the respiratory system and with available chest CT scans were retrospectively enrolled (years 2002-2018): 41 patients with local pulmonary parenchymal, 20 with local tracheobronchial, and 6 with systemic amyloidosis. CT was scored for findings like mass lesions, nodules, cysts, lymphadenopathy, calcifications and pleural, interstitial and tracheobronchial manifestations. Clinical data and imaging findings' frequencies among patients with local pulmonary parenchymal and tracheobronchial amyloidosis were compared. RESULTS Patients with local pulmonary parenchymal amyloidosis were older (67 vs. 56 years; P = 0.013) and less frequently symptomatic for cough (24% vs. 70%; P = 0.018) and bronchopulmonal infections (7% vs. 55%; P < 0.001) than patients with tracheobronchial amyloidosis. Local pulmonary parenchymal amyloidosis showed higher frequency of mass-like lesions (41% vs. 0%; P = 0.002) and nodules (95% vs. 20%; P < 0.001, with 10 or more nodules in 56% vs. 0%; P < 0.001 and predominantly pleura-associated in 32% vs. 0%; P = 0.02). Tracheobronchial amyloidosis leads to wall thickening of the bronchi (100% vs. 5%; P < 0.001) and the trachea (70% vs. 2%; P < 0.001). Systemic amyloidosis went along with a predominant alveolar septal pattern in 4 out of 6 patients. CONCLUSION Patients with local pulmonary parenchymal amyloidosis differ significantly from patients with tracheobronchial amyloidosis regarding clinical data and CT findings' frequencies. Being familiar with radiological manifestations of all three respiratory amyloidosis distribution patterns is essential to accelerate the diagnosis.
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Affiliation(s)
- Simone Christine Brandelik
- Department of Diagnostic and Interventional Radiology, Heidelberg University Hospital, Im Neuenheimer Feld 110, 69120 Heidelberg, Germany; Amyloidosis Center, Heidelberg University Hospital, Im Neuenheimer Feld 410, 69120 Heidelberg, Germany.
| | - Claus Peter Heussel
- Department of Diagnostic and Interventional Radiology, Heidelberg University Hospital, Im Neuenheimer Feld 110, 69120 Heidelberg, Germany; Translational Lung Research Center Heidelberg (TLRC), Member of the German Center for Lung Research (DZL), Im Neuenheimer Feld 110, 69120 Heidelberg, Germany; Department of Diagnostic and Interventional Radiology with Nuclear Medicine, Thoraxklinik at Heidelberg University Hospital, Röntgenstrasse 1, 69126 Heidelberg, Germany
| | - Hans-Ulrich Kauczor
- Department of Diagnostic and Interventional Radiology, Heidelberg University Hospital, Im Neuenheimer Feld 110, 69120 Heidelberg, Germany; Translational Lung Research Center Heidelberg (TLRC), Member of the German Center for Lung Research (DZL), Im Neuenheimer Feld 110, 69120 Heidelberg, Germany; Department of Diagnostic and Interventional Radiology with Nuclear Medicine, Thoraxklinik at Heidelberg University Hospital, Röntgenstrasse 1, 69126 Heidelberg, Germany
| | - Christoph Röcken
- Department of Pathology, Christian-Albrechts-University Kiel, Arnold-Heller-Str.3/14, 24105 Kiel, Germany
| | - Laura Huber
- Medical Department V, Hematology/Oncology/Rheumatology, Heidelberg University Hospital, Im Neuenheimer Feld 410, 69120 Heidelberg, Germany; Amyloidosis Center, Heidelberg University Hospital, Im Neuenheimer Feld 410, 69120 Heidelberg, Germany
| | - Marco Basset
- Medical Department V, Hematology/Oncology/Rheumatology, Heidelberg University Hospital, Im Neuenheimer Feld 410, 69120 Heidelberg, Germany; Amyloidosis Center, Heidelberg University Hospital, Im Neuenheimer Feld 410, 69120 Heidelberg, Germany; Amyloidosis Research and Treatment Center, IRCCS Policlinico San Matteo, Department of Molecular Medicine, University of Pavia, Pavia, Italy
| | - Christoph Kimmich
- Medical Department V, Hematology/Oncology/Rheumatology, Heidelberg University Hospital, Im Neuenheimer Feld 410, 69120 Heidelberg, Germany; Amyloidosis Center, Heidelberg University Hospital, Im Neuenheimer Feld 410, 69120 Heidelberg, Germany
| | - Stefan Olaf Schönland
- Medical Department V, Hematology/Oncology/Rheumatology, Heidelberg University Hospital, Im Neuenheimer Feld 410, 69120 Heidelberg, Germany; Amyloidosis Center, Heidelberg University Hospital, Im Neuenheimer Feld 410, 69120 Heidelberg, Germany
| | - Ute Hegenbart
- Medical Department V, Hematology/Oncology/Rheumatology, Heidelberg University Hospital, Im Neuenheimer Feld 410, 69120 Heidelberg, Germany; Amyloidosis Center, Heidelberg University Hospital, Im Neuenheimer Feld 410, 69120 Heidelberg, Germany
| | - Johanna Nattenmüller
- Department of Diagnostic and Interventional Radiology, Heidelberg University Hospital, Im Neuenheimer Feld 110, 69120 Heidelberg, Germany; Translational Lung Research Center Heidelberg (TLRC), Member of the German Center for Lung Research (DZL), Im Neuenheimer Feld 110, 69120 Heidelberg, Germany; Amyloidosis Center, Heidelberg University Hospital, Im Neuenheimer Feld 410, 69120 Heidelberg, Germany
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Woestmann C, Ju C, Hinzmann B, Yaung SJ, Thomas M, Heussel CP, Kriegsmann M, Meister M, Schneider M, Herth F, Muley T, Wehnl B, Palma JF, Jiang Y. Disease monitoring and TKI resistance mutations of EGFR mutation-positive NSCLC patients via circulating tumor DNA. J Clin Oncol 2020. [DOI: 10.1200/jco.2020.38.15_suppl.e21627] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
e21627 Background: 15–40% of NSCLC adenocarcinoma patients harbor EGFR sensitizing mutations. Tyrosine kinase inhibitors (TKI) provide significant clinical benefit in this population, yet all patients will develop resistance. Liquid biopsy has been demonstrated to reliably identify tumor associated somatic EGFR mutations. Quantitative assessment of mutated EGFR driven tumors could potentially be used to monitor disease progression, to assess therapeutic response, and to identify resistance mechanisms. Methods: 106 longitudinal plasma samples from 16 NSCLC patients who were treated with osimertinib as either first line or second line therapy were collected. A series of plasma samples collected during treatment and at the time of disease progression were analyzed with the AVENIO ctDNA Surveillance kit*. Mutations at each time point were identified and reported by the AVENIO software v2.0*. The mutation profile of each patient at different timepoints along with the treatment journey was examined in combination with clinical outcome data. Results: EGFR sensitizing mutations were detected in all plasma samples by sequencing except in 3 cases. Patients responsive to anti-EGFR therapy showed a rapid decrease of EGFR driver mutations to non-detectable levels. Meanwhile, patients who had stable disease or rapid disease progression had stable or slightly decreasing ctDNA levels after receiving the treatment. One patient had a MET amplification, FBXL7 SNV, and EGFR T790M detected at the time of disease progression which were not detected at baseline. One patient had both EGFR L858R and T790M mutations. This patient progressed very quickly on erlotinib. Detection of the T790M mutation decreased upon osimertinib administration, however, the L858R mutation level stayed the same. TP53 mutations were elevated in 3 patients at the time of progression, and could potentially be related to anti-EGFR resistance. Conclusions: This study clearly demonstrated that liquid biopsy could identify resistance mutations beyond EGFR prior to clinical progression. Plasma samples collected prior to or at disease progression could facilitate identification of novel resistant mutations to TKI therapy. Further studies to demonstrate the clinical utility of serial blood EGFR testing in NSCLC management are necessary. *For Research Use Only. Not for use in diagnostic procedures.
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Affiliation(s)
| | | | | | | | - Michael Thomas
- Thoraxklinik at Heidelberg University Hospital, Heidelberg, Germany
| | | | - Mark Kriegsmann
- Institute of Pathology, University Hospital Heidelberg, Heidelberg, Germany
| | - Michael Meister
- Thoraxklinik at Heidelberg University Hospital, Heidelberg, Germany
| | - Marc Schneider
- Thoraxklinik at Heidelberg University Hospital, Heidelberg, Germany
| | - Felix Herth
- Thoraxklinik at Heidelberg University Hospital, Heidelberg, Germany
| | - Thomas Muley
- Thoraxklinik at Heidelberg University Hospital, Heidelberg, Germany
| | | | | | - Yuqiu Jiang
- Roche Sequencing Solutions, Inc., Pleasanton, CA
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29
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Torrisi SE, Kahn N, Wälscher J, Sarmand N, Polke M, Lars K, Eichinger M, Heussel CP, Palmucci S, Sambataro FM, Sambataro G, Sambataro D, Vancheri C, Kreuter M. Possible value of antifibrotic drugs in patients with progressive fibrosing non-IPF interstitial lung diseases. BMC Pulm Med 2019; 19:213. [PMID: 31718637 PMCID: PMC6852748 DOI: 10.1186/s12890-019-0937-0] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2019] [Accepted: 09/11/2019] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Fibrosing, non-idiopathic pulmonary fibrosis (non-IPF) interstitial lung diseases (fILDs) are a heterogeneous group of diseases characterized by a different amount of inflammation and fibrosis. Therapy is currently based on corticosteroids and/or immunomodulators. However, response to these therapies is highly variable, sometimes without meaningful improvement, especially in more fibrosing forms. Pirfenidone and nintedanib have recently demonstrated to reduce functional decline in patients with IPF. However, their antifibrotic mechanism makes these two drugs an interesting approach for treatment of fibrosing ILDs other than IPF. OBJECTIVES We here report our experience with antifibrotic drugs in fibrosing non-IPF ILDs patients having a progressive phenotype during immunosuppressive therapy. METHODS Patients with a multidisciplinary team diagnosis of fibrosing non-IPF ILDs experiencing a progressive phenotype during treatment with corticosteroids and/or immunomodulators between October-2014 and January-2018 at our tertiary referral Center for ILDs were retrospectively analyzed. Antifibrotic therapy was administered after application with the respective health insurance company and after consent by the patient. Pulmonary-function-tests and follow-up visits were performed every 6 ± 1 months. RESULTS Eleven patients were treated with antifibrotic drugs (8 males, mean age 62 ± 12.8 years, mean FVC% 62.8 ± 22.3, mean DLCO% 35.5 ± 10.7, median follow-up under antifibrotic treatment 11.1 months). Patients had a diagnosis of unclassifiable ILD in 6 cases, pleuroparenchymal fibroelastosis in 2 cases, idiopathic-NSIP in 1 case, asbestos-related ILD in 1 case and Hermansky-Pudlak syndrome in 1 case. Treatment before antifibrotics consisted of corticosteroids in all patients: 5 combined with Azathioprin, 1 with either methotrexate or cyclophosphamide (i.v.). Ten patients were treated with pirfenidone (2403 mg/die) and 1 with nintedanib (300 mg/die). Median FVC was 56, 56, 50%, at time points - 24, - 12, - 6 before initiation, 44% at time of initiation and 46.5% at 6 months after initiation of antifibrotic treatment. Antifibrotic treatment was generally well tolerated with a need of dose reduction in 2 cases (rash and nausea) and early termination in 3 cases. CONCLUSIONS Antifibrotic treatment may be a valuable treatment option in patients with progressive fibrosing non-IPF ILD if currently no other treatment options exist. However, prospective, randomized clinical trials are urgently needed to assess the real impact of antifibrotic therapy in these patients.
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Affiliation(s)
- Sebastiano Emanuele Torrisi
- Center for interstitial and rare lung diseases, Pneumology, Thoraxklinik, University of Heidelberg, Germany and German Center for Lung Research, Heidelberg, Germany.,Department of Clinical and Experimental Medicine, Regional Referral Centre for Rare Lung Diseases, A.O.U. Policlinico-Vittorio Emanuele, University of Catania, Catania, Italy
| | - Nicolas Kahn
- Center for interstitial and rare lung diseases, Pneumology, Thoraxklinik, University of Heidelberg, Germany and German Center for Lung Research, Heidelberg, Germany
| | - Julia Wälscher
- Center for interstitial and rare lung diseases, Pneumology, Thoraxklinik, University of Heidelberg, Germany and German Center for Lung Research, Heidelberg, Germany
| | - Nilab Sarmand
- Center for interstitial and rare lung diseases, Pneumology, Thoraxklinik, University of Heidelberg, Germany and German Center for Lung Research, Heidelberg, Germany
| | - Markus Polke
- Center for interstitial and rare lung diseases, Pneumology, Thoraxklinik, University of Heidelberg, Germany and German Center for Lung Research, Heidelberg, Germany
| | - Kehler Lars
- Center for interstitial and rare lung diseases, Pneumology, Thoraxklinik, University of Heidelberg, Germany and German Center for Lung Research, Heidelberg, Germany
| | - Monika Eichinger
- Department of Diagnostic and Interventional Radiology with Nuclear Medicine, Thoraxklinik, University of Heidelberg and Translational Lung Research Center Heidelberg, member of the German Center for Lung Research, Heidelberg, Germany
| | - Claus Peter Heussel
- Department of Diagnostic and Interventional Radiology with Nuclear Medicine, Thoraxklinik, University of Heidelberg and Translational Lung Research Center Heidelberg, member of the German Center for Lung Research, Heidelberg, Germany
| | - Stefano Palmucci
- Radiology I Unit, Department of Medical Surgical Sciences and Advanced Technologies, University Hospital "Policlinico-Vittorio Emanuele", Catania, Italy
| | - Francesca Maria Sambataro
- Department of Diagnostic and Interventional Radiology with Nuclear Medicine, Thoraxklinik, University of Heidelberg and Translational Lung Research Center Heidelberg, member of the German Center for Lung Research, Heidelberg, Germany.,Department of Imaging, Azienda Ospedaliero Universitaria Città della Salute e della Scienza, CTO Hospital, Via Zuretti 29, 10126, Turin, Italy.,Artroreuma s.r.l. Outpatient of Rheumatology accredited with the National Health System, c.so S. Vito 53, 95030, Mascalucia, CT, Italy
| | - Gianluca Sambataro
- Department of Clinical and Experimental Medicine, Regional Referral Centre for Rare Lung Diseases, A.O.U. Policlinico-Vittorio Emanuele, University of Catania, Catania, Italy.,Artroreuma s.r.l. Outpatient of Rheumatology accredited with the National Health System, c.so S. Vito 53, 95030, Mascalucia, CT, Italy
| | - Domenico Sambataro
- Department of Clinical and Experimental Medicine, Internal Medicine Unit, Cannizzaro Hospital, University of Catania, Via Messina 829, 95100, Catania, Italy
| | - Carlo Vancheri
- Department of Clinical and Experimental Medicine, Regional Referral Centre for Rare Lung Diseases, A.O.U. Policlinico-Vittorio Emanuele, University of Catania, Catania, Italy
| | - Michael Kreuter
- Center for interstitial and rare lung diseases, Pneumology, Thoraxklinik, University of Heidelberg, Germany and German Center for Lung Research, Heidelberg, Germany.
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30
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deSouza NM, Achten E, Alberich-Bayarri A, Bamberg F, Boellaard R, Clément O, Fournier L, Gallagher F, Golay X, Heussel CP, Jackson EF, Manniesing R, Mayerhofer ME, Neri E, O'Connor J, Oguz KK, Persson A, Smits M, van Beek EJR, Zech CJ. Validated imaging biomarkers as decision-making tools in clinical trials and routine practice: current status and recommendations from the EIBALL* subcommittee of the European Society of Radiology (ESR). Insights Imaging 2019; 10:87. [PMID: 31468205 PMCID: PMC6715762 DOI: 10.1186/s13244-019-0764-0] [Citation(s) in RCA: 51] [Impact Index Per Article: 10.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2019] [Accepted: 06/28/2019] [Indexed: 12/12/2022] Open
Abstract
Observer-driven pattern recognition is the standard for interpretation of medical images. To achieve global parity in interpretation, semi-quantitative scoring systems have been developed based on observer assessments; these are widely used in scoring coronary artery disease, the arthritides and neurological conditions and for indicating the likelihood of malignancy. However, in an era of machine learning and artificial intelligence, it is increasingly desirable that we extract quantitative biomarkers from medical images that inform on disease detection, characterisation, monitoring and assessment of response to treatment. Quantitation has the potential to provide objective decision-support tools in the management pathway of patients. Despite this, the quantitative potential of imaging remains under-exploited because of variability of the measurement, lack of harmonised systems for data acquisition and analysis, and crucially, a paucity of evidence on how such quantitation potentially affects clinical decision-making and patient outcome. This article reviews the current evidence for the use of semi-quantitative and quantitative biomarkers in clinical settings at various stages of the disease pathway including diagnosis, staging and prognosis, as well as predicting and detecting treatment response. It critically appraises current practice and sets out recommendations for using imaging objectively to drive patient management decisions.
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Affiliation(s)
- Nandita M deSouza
- Cancer Research UK Imaging Centre, The Institute of Cancer Research and The Royal Marsden Hospital, Downs Road, Sutton, Surrey, SM2 5PT, UK.
| | | | | | - Fabian Bamberg
- Department of Radiology, University of Freiburg, Freiburg im Breisgau, Germany
| | | | | | | | | | | | - Claus Peter Heussel
- Universitätsklinik Heidelberg, Translational Lung Research Center (TLRC), German Center for Lung Research (DZL), University of Heidelberg, Im Neuenheimer Feld 156, 69120, Heidelberg, Germany
| | - Edward F Jackson
- University of Wisconsin School of Medicine and Public Health, Madison, WI, USA
| | - Rashindra Manniesing
- Department of Radiology and Nuclear Medicine, Radboud University Medical Center, Geert Grooteplein 10, 6525, GA, Nijmegen, The Netherlands
| | | | - Emanuele Neri
- Department of Translational Research, University of Pisa, Pisa, Italy
| | - James O'Connor
- Division of Cancer Sciences, University of Manchester, Manchester, UK
| | | | | | - Marion Smits
- Department of Radiology and Nuclear Medicine (Ne-515), Erasmus MC, PO Box 2040, 3000, CA, Rotterdam, The Netherlands
| | - Edwin J R van Beek
- Edinburgh Imaging, Queen's Medical Research Institute, Edinburgh Bioquarter, 47 Little France Crescent, Edinburgh, UK
| | - Christoph J Zech
- University Hospital Basel, Radiology and Nuclear Medicine, University of Basel, Petersgraben 4, CH-4031, Basel, Switzerland
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31
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Palm V, Rengier F, Rajiah P, Heussel CP, Partovi S. Acute Pulmonary Embolism: Imaging Techniques, Findings, Endovascular Treatment and Differential Diagnoses. ROFO-FORTSCHR RONTG 2019; 192:38-49. [PMID: 31137046 DOI: 10.1055/a-0900-4200] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
BACKGROUND Acute thrombotic pulmonary embolism (PE) is a common and potentially fatal event with imaging playing a pivotal role in the diagnosis and management of these patients. METHOD This review discusses imaging techniques, diagnostic algorithms, imaging findings and endovascular treatment of acute thrombotic PE, and illustrates important differential diagnoses relating to the spectrum of acute non-thrombotic PE and non-embolic pulmonary artery disease. The review emphasizes information relevant for everyday radiological practice and highlights recent advances that can be readily applied in the clinical routine. RESULTS/CONCLUSION Computed tomography pulmonary angiography (CTPA) is the current reference standard for the diagnosis of acute PE. Ventilation and perfusion (VQ) scanning or - in centers with adequate expertise - magnetic resonance imaging (MRI) is indicated in pregnant or young patients and patients with contraindications to iodinated contrast. Invasive angiography is reserved for patients with intended endovascular treatment. Artifacts, acute non-thrombotic PE, chronic PE and non-embolic pulmonary artery diseases should always be considered as differential diagnoses. KEY POINTS · CTPA is the reference standard for the diagnosis of acute PE.. · MRI for acute PE should only be performed in centers with adequate expertise.. · Invasive angiography is reserved for patients with intended endovascular treatment.. · Artifacts and non-embolic pulmonary artery diseases can mimic acute pulmonary thromboembolism.. · Non-thrombotic and chronic PE are also differential diagnoses of acute pulmonary thromboembolism.. CITATION FORMAT · Palm V, Rengier F, Rajiah P et al. Acute Pulmonary Embolism: Imaging Techniques, Findings, Endovascular Treatment and Differential Diagnoses. Fortschr Röntgenstr 2020; 192: 38 - 49.
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Affiliation(s)
- Viktoria Palm
- Diagnostic and Interventional Radiology, University Hospital Heidelberg, Heidelberg, Germany
| | - Fabian Rengier
- Translational Lung Research Center Heidelberg (TLRC), Member of the German Center for Lung Research (DZL), University of Heidelberg, Heidelberg, Germany
| | - Prabhakar Rajiah
- Department of Radiology, Cardiothoracic Imaging, UT Southwestern Medical Center, Dallas, United States
| | - Claus Peter Heussel
- Diagnostic and Interventional Radiology with Nuclear Medicine, Thoraxklinik at University Hospital Heidelberg, Heidelberg, Germany
| | - Sasan Partovi
- Interventional Radiology Section, Imaging Institute, Cleveland Clinic Foundation, Cleveland, Ohio, United States
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32
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Yaung SJ, Xi L, Woestmann C, Ju C, Klass DM, Casey F, Hinzmann B, Heussel CP, Thomas M, Herth F, Muley T, Wehnl B, Palma JF, Ma XM. Assessing the impact of clonal hematopoiesis in disease monitoring using targeted cell-free DNA (cfDNA) sequencing technology. J Clin Oncol 2019. [DOI: 10.1200/jco.2019.37.15_suppl.e14530] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
e14530 Background: Somatic variants found in plasma cell-free DNA (cfDNA) may derive from either solid tumors or clonal hematopoiesis (CH). Little is known about how this may impact plasma-based longitudinal disease monitoring using targeted sequencing of circulating tumor DNA (ctDNA). Methods: To assess the potential impact of CH in disease monitoring, we evaluated monitoring algorithms by targeted sequencing with and without matched peripheral blood mononuclear cells (PBMC). Samples were collected from a prospective observational study, where 62 late stage lung adenocarcinoma subjects were treated with first-line chemo or chemoradiation therapy. Pre-treatment plasma cfDNA and matched PBMC were analyzed with the AVENIO ctDNA Surveillance Kit (For Research Use Only, not for use in diagnostic procedures), a sequencing panel of 198 kilobases targeting cancer genes. Median input amounts of 25 ng cfDNA and 50 ng PBMC DNA were sequenced to median deduplicated depths of 4582 and 6134, respectively. Results: A median of 120 single nucleotide variants were detected per cfDNA sample, with 93.1% of these identified in matched PBMC. Most PBMC-matched cfDNA variants were germline SNPs, with allele frequency (AF) ~ 50% or 100%. A median of 1 (range 0-5) PBMC-matched cfDNA variants per sample were detected with an AF < 10%, consistent with CH. The number of these variants was positively associated with age (p-value = 0.0039) and the most frequently mutated gene was TP53. The remaining somatic variants (i.e., in cfDNA and not PBMC) had an AF range 0.03-40.9%. These PBMC-informed variants (median of 7 per sample) were used in longitudinal monitoring in the first post-treatment plasma sample to assess early response to therapy. Association between ctDNA level and progression-free survival using the same monitoring algorithm yielded nearly identical results on somatic variants derived from filtering approaches independent of matched PBMC (HR 0.32; 95% CI 0.16 - 0.65; log-rank P = 0.0009) and the PBMC-informed method (HR 0.31; 95% CI 0.14 - 0.66; log-rank P = 0.0013). Conclusions: A targeted panel focused on solid tumors by design has limited impact from CH. For disease monitoring applications in a non-MRD setting, measuring multiple variants instead of a single variant further enables robust classifiers that can moderate the impact of variants, if any, from CH.
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Affiliation(s)
| | - Liu Xi
- Roche Sequencing Solutions, Inc., Pleasanton, CA
| | | | | | | | - Fergal Casey
- Roche Sequencing Solutions, Inc., Pleasanton, CA
| | | | | | - Michael Thomas
- Thoraxklinik at Heidelberg University Hospital, Heidelberg, Germany
| | - Felix Herth
- Thoraxklinik at Heidelberg University Hospital, Heidelberg, Germany
| | - Thomas Muley
- Thoraxklinik at Heidelberg University Hospital, Heidelberg, Germany
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33
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Ma XM, Ju C, Woestmann C, Xi L, Yaung SJ, Hinzmann B, Thomas M, Heussel CP, Lasitschka F, Meister M, Schneider M, Herth F, Muley T, Wehnl B, Palma JF. Early assessment of therapy response in non-small cell lung cancer (NSCLC) via longitudinal ctDNA analysis. J Clin Oncol 2019. [DOI: 10.1200/jco.2019.37.15_suppl.e20701] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
e20701 Background: Quantifying circulating tumor DNA (ctDNA) is an emerging method to non-invasively assess treatment effect for solid tumors. Despite disease heterogeneity in NSCLC, we set out to identify a broadly applicable ctDNA-based method for disease monitoring. By employing plasma taken during early treatment cycles, we tested whether early response assessed by ctDNA level could predict treatment effect. Methods: Using a 197-gene NGS assay, the AVENIO ctDNA Surveillance Kit (For Research Use Only, not for use in diagnostic procedures), we measured ctDNA levels in post-treatment plasma samples based on variants identified at baseline. We used samples from an observational German Lung Cancer Multi-Marker Study. In a cohort of 83 stage IV lung adenocarcinoma treated with first-line chemo or chemoradiation therapies, we evaluated the association between survival and ctDNA levels in the first available post-treatment plasma sample (median number of days after start of treatment = 23). We used a ctDNA-based monitoring algorithm, and applied it to an independent set of 22 late stage lung squamous cell carcinoma (SCC) that also underwent chemo or chemoradiation therapies to further evaluate the algorithm in different histology subtypes. Results: We divided the 83 adenocarcinoma cohort into training (n = 53) and test (n = 30) sets. We found that subjects with longer progression free survival (PFS) had mean allele fraction (AF) < 1% in the training set. We applied the classifier to our validation set and found that subjects with mean AF < 1% had longer PFS (HR 0.35; 95% CI 0.12 - 0.93; log-rank P = 0.028) and overall survival (OS) (HR 0.29; 95% CI 0.09 - 0.89; log-rank P = 0.021). Using cutoffs identified in adenocarcinoma, we applied the same algorithms to the SCC cohort. Subjects with mean AF < 1% had longer PFS (HR 0.26; 95% CI 0.10 - 0.71; log-rank P = 0.005) and OS (HR 0.12; 95% CI 0.05 - 0.51; log-rank P = 0.001). Conclusions: Even in heterogeneous diseases such as NSCLC, changes in ctDNA levels in response to treatment may prove to be a valuable way of identifying subjects who may not benefit, which is earlier than current standard of care methods like computed tomography (CT) scan. Future prospective studies to confirm these results are warranted.
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Affiliation(s)
| | | | | | - Liu Xi
- Roche Sequencing Solutions, Inc., Pleasanton, CA
| | | | | | - Michael Thomas
- Thoraxklinik at Heidelberg University Hospital, Heidelberg, Germany
| | | | - Felix Lasitschka
- Institute of Pathology, University Hospital Heidelberg, Heidelberg, Germany
| | - Michael Meister
- Thoraxklinik at Heidelberg University Hospital, Null, Germany
| | - Marc Schneider
- Thoraxklinik at Heidelberg University Hospital, Heidelberg, Germany
| | - Felix Herth
- Thoraxklinik at Heidelberg University Hospital, Heidelberg, Germany
| | - Thomas Muley
- Thoraxklinik at Heidelberg University Hospital, Heidelberg, Germany
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34
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Melzig C, Wörz S, Egenlauf B, Partovi S, Rohr K, Grünig E, Kauczor HU, Heussel CP, Rengier F. Combined automated 3D volumetry by pulmonary CT angiography and echocardiography for detection of pulmonary hypertension. Eur Radiol 2019; 29:6059-6068. [PMID: 30963276 DOI: 10.1007/s00330-019-06188-7] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/26/2018] [Revised: 02/13/2019] [Accepted: 03/20/2019] [Indexed: 01/28/2023]
Abstract
OBJECTIVES To assess the diagnostic accuracy of automated 3D volumetry of central pulmonary arteries using computed tomography pulmonary angiography (CTPA) for suspected pulmonary hypertension alone and in combination with echocardiography. METHODS This retrospective diagnostic accuracy study included 70 patients (mean age 66.7, 48 female) assessed for pulmonary hypertension by CTPA and transthoracic echocardiography with estimation of the pulmonary arterial systolic pressure (PASP). Gold standard right heart catheterisation with measurement of the invasive mean pulmonary arterial pressure (invasive mPAP) served as the reference. Volumes of the main, right and left pulmonary arteries (MPA, RPA and LPA) were computed using automated 3D segmentation. For comparison, axial dimensions were manually measured. A linear regression model was established for prediction of mPAP (predicted mPAP). RESULTS MPA, RPA and LPA volumes were significantly increased in patients with vs. without pulmonary hypertension (all p < 0.001). Of all measures, MPA volume demonstrated the strongest correlation with invasive mPAP (r = 0.76, p < 0.001). Predicted mPAP using MPA volume and echocardiographic PASP as covariates showed excellent correlation with invasive mPAP (r = 0.89, p < 0.001). Area under the curves for predicting pulmonary hypertension were 0.94 for predicted mPAP, compared to 0.90 for MPA volume and 0.92 for echocardiographic PASP alone. A predicted mPAP > 25.8 mmHg identified pulmonary hypertension with sensitivity, specificity, positive and negative predictive values of 86%, 93%, 95% and 81%, respectively. CONCLUSIONS Automated 3D volumetry of central pulmonary arteries based on CTPA may be used in conjunction with echocardiographic pressure estimates to noninvasively predict mPAP and pulmonary hypertension as confirmed by gold standard right heart catheterisation with higher diagnostic accuracy than either test alone. KEY POINTS • This diagnostic accuracy study derived a regression model for noninvasive prediction of invasively measured mean pulmonary arterial pressure as assessed by gold standard right heart catheterisation. • This regression model using automated 3D volumetry of the central pulmonary arteries based on CT pulmonary angiography in conjunction with the echocardiographic pressure estimate predicted pulmonary arterial pressure and the presence of pulmonary hypertension with good diagnostic accuracy. • The combination of automated 3D volumetry and echocardiographic pressure estimate in the regression model provided superior diagnostic accuracy compared to each parameter alone.
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Affiliation(s)
- Claudius Melzig
- Department of Diagnostic and Interventional Radiology, Heidelberg University Hospital, Im Neuenheimer Feld 110, 69120, Heidelberg, Germany.,Translational Lung Research Center Heidelberg (TLRC), Member of the German Center for Lung Research (DZL), University of Heidelberg, Heidelberg, Germany
| | - Stefan Wörz
- Biomedical Computer Vision Group, BIOQUANT, IPMB and German Cancer Research Center (DKFZ), University of Heidelberg, Heidelberg, Germany
| | - Benjamin Egenlauf
- Centre for Pulmonary Hypertension, Thoraxklinik at Heidelberg University Hospital, Heidelberg, Germany
| | - Sasan Partovi
- Department of Radiology, Section of Interventional Radiology, Cleveland Clinic Foundation, Cleveland, OH, USA
| | - Karl Rohr
- Biomedical Computer Vision Group, BIOQUANT, IPMB and German Cancer Research Center (DKFZ), University of Heidelberg, Heidelberg, Germany
| | - Ekkehard Grünig
- Translational Lung Research Center Heidelberg (TLRC), Member of the German Center for Lung Research (DZL), University of Heidelberg, Heidelberg, Germany.,Centre for Pulmonary Hypertension, Thoraxklinik at Heidelberg University Hospital, Heidelberg, Germany
| | - Hans-Ulrich Kauczor
- Department of Diagnostic and Interventional Radiology, Heidelberg University Hospital, Im Neuenheimer Feld 110, 69120, Heidelberg, Germany.,Translational Lung Research Center Heidelberg (TLRC), Member of the German Center for Lung Research (DZL), University of Heidelberg, Heidelberg, Germany
| | - Claus Peter Heussel
- Department of Diagnostic and Interventional Radiology, Heidelberg University Hospital, Im Neuenheimer Feld 110, 69120, Heidelberg, Germany.,Translational Lung Research Center Heidelberg (TLRC), Member of the German Center for Lung Research (DZL), University of Heidelberg, Heidelberg, Germany.,Department of Radiology, Thoraxklinik at Heidelberg University Hospital, Heidelberg, Germany
| | - Fabian Rengier
- Department of Diagnostic and Interventional Radiology, Heidelberg University Hospital, Im Neuenheimer Feld 110, 69120, Heidelberg, Germany. .,Translational Lung Research Center Heidelberg (TLRC), Member of the German Center for Lung Research (DZL), University of Heidelberg, Heidelberg, Germany. .,Department of Radiology, German Cancer Research Center (DKFZ), Heidelberg, Germany.
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35
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Egenlauf B, Schuhmann M, Giese T, Junghanss T, Stojkovic M, Tintelnot K, de Hoog S, Greil J, Richter E, Vehresschild M, Heussel CP, Herth FJF, Kreuter M. Disseminated Mycosis by Arthrocladium fulminans Jeopardizing a Patient with GATA2 Deficiency. Respiration 2019; 97:472-475. [PMID: 30928982 DOI: 10.1159/000493429] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2018] [Accepted: 08/28/2018] [Indexed: 11/19/2022] Open
Abstract
GATA2 deficiency is characterized by monocytopenia, deficiency of dendritic cells, and a variable degree of lymphocytopenia affecting B cells and NK cells, leading to an enhanced risk of mycobacterial, viral, and fungal infections. Here we present a patient with a heterozygous intronic GATA2 mutation who acquired a fatal disseminated mycosis due to the black yeast-like fungus Arthrocladium fulminans following an infection with Mycobacterium sherrisii. This case illustrates that in patients with severe uncommon infections, immunodeficiency syndromes must be ruled out.
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Affiliation(s)
- Benjamin Egenlauf
- Pneumology and Respiratory Critical Care Medicine, Thoraxklinik at University of Heidelberg, Heidelberg, Germany
| | - Maren Schuhmann
- Pneumology and Respiratory Critical Care Medicine, Thoraxklinik at University of Heidelberg, Heidelberg, Germany
| | - Thomas Giese
- Institute of Immunology, University Hospital Heidelberg, Heidelberg, Germany
| | - Thomas Junghanss
- Section of Clinical Tropical Medicine, Heidelberg University Hospital, Heidelberg, Germany
| | - Marija Stojkovic
- Section of Clinical Tropical Medicine, Heidelberg University Hospital, Heidelberg, Germany
| | - Kathrin Tintelnot
- Robert Koch Institute, Division 16, Mycotic and Parasitic Agents and Mycobacteria, Berlin, Germany
| | - Sybren de Hoog
- CBS-KNAW Fungal Biodiversity Centre, Utrecht, The Netherlands
| | - Johann Greil
- Department of Pediatric Oncology, Hematology and Immunology, University Hospital Heidelberg, Heidelberg, Germany
| | - Elvira Richter
- National Reference Center for Mycobacteria, Research Center Borstel, Borstel, Germany
| | - Maria Vehresschild
- Department I of Internal Medicine, University of Cologne, Cologne, Germany
| | - Claus Peter Heussel
- Department of Diagnostic and Interventional Radiology with Nuclear Medicine, Thoraxklinik at University of Heidelberg, Heidelberg, Germany.,Department of Diagnostic and Interventional Radiology, University of Heidelberg, Heidelberg, Germany.,Translational Lung Research Center Heidelberg (TLRC), Member of the German Center for Lung Research (DZL), Heidelberg, Germany
| | - Felix J F Herth
- Pneumology and Respiratory Critical Care Medicine, Thoraxklinik at University of Heidelberg, Heidelberg, Germany.,Translational Lung Research Center Heidelberg (TLRC), Member of the German Center for Lung Research (DZL), Heidelberg, Germany
| | - Michael Kreuter
- Center for Interstitial and Rare Lung Diseases, Thoraxklinik at University of Heidelberg, Heidelberg, Germany, .,Translational Lung Research Center Heidelberg (TLRC), Member of the German Center for Lung Research (DZL), Heidelberg, Germany,
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36
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Flechsig P, Hural O, Kreuter M, Eichhorn M, HEUßEL G, Sachpekidis C, Kauczor HU, Haberkorn U, Heussel CP, Eichinger M. Impact of FDG-PET on the Detection of Patients with Lung Cancer at High Risk for ILD. In Vivo 2019; 32:1457-1462. [PMID: 30348701 DOI: 10.21873/invivo.11399] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2018] [Revised: 06/25/2018] [Accepted: 06/28/2018] [Indexed: 01/02/2023]
Abstract
BACKGROUND/AIM Idiopathic pulmonary fibrosis IPF is a type of interstitial lung disease (ILD) with poor prognosis. Lung cancer (LC) is a frequent complication in IPF, where all therapeutic options are potential triggers for acute exacerbation of IPF. PATIENTS AND METHODS Patients with 2-deoxy-2-fluoro-D-glucose-positron emission tomography/computer tomography (FDG-PET/CT) results before lobectomy for LC with and without (n=10 each) signs of ILD in initial imaging and after-care CT were retrospectively analyzed. FDG uptake was calculated as the maximum standardized uptake value (SUVmax) in the lung periphery divided by the SUVmax of the mediastinal blood pool (rSUVmax). Regional increase of fibrosis and ground-glass features in lobe-based CT analysis was used as standard reference. RESULTS Patients with LC with ILD presented a significantly higher rSUVmax of 0.57 compared to patients without ILD with rSUVmax 0.47 (p<0.001). CONCLUSION rSUVmax seems to be a valuable imaging surrogate in predicting patients with LC with increased risk for progressive ILD associated with thoracic surgery.
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Affiliation(s)
- Paul Flechsig
- Department of Nuclear Medicine, University Hospital Heidelberg, Heidelberg, Germany .,Translational Lung Research Center Heidelberg, Member of the German Center for Lung Research DZL, Heidelberg, Germany.,Division of Diagnostic and Interventional Radiology with Nuclear Medicine, Thorax Clinic, University of Heidelberg, Heidelberg, Germany
| | - Olena Hural
- Division of Diagnostic and Interventional Radiology with Nuclear Medicine, Thorax Clinic, University of Heidelberg, Heidelberg, Germany
| | - Michael Kreuter
- Translational Lung Research Center Heidelberg, Member of the German Center for Lung Research DZL, Heidelberg, Germany.,Centre for Interstitial and Rare Lung Diseases, Pneumology and Respiratory Critical Care Medicine, Thorax Clinic, University of Heidelberg, Heidelberg, Germany
| | - Martin Eichhorn
- Translational Lung Research Center Heidelberg, Member of the German Center for Lung Research DZL, Heidelberg, Germany.,Department of Thoracic Surgery, Thorax Clinic, University of Heidelberg, Heidelberg, Germany
| | - Gudula HEUßEL
- Translational Lung Research Center Heidelberg, Member of the German Center for Lung Research DZL, Heidelberg, Germany.,Division of Diagnostic and Interventional Radiology with Nuclear Medicine, Thorax Clinic, University of Heidelberg, Heidelberg, Germany.,Department of Thoracic Surgery, Thorax Clinic, University of Heidelberg, Heidelberg, Germany
| | - Christos Sachpekidis
- Department of Nuclear Medicine, University Hospital Heidelberg, Heidelberg, Germany.,Clinical Cooperation Unit, Department of Nuclear Medicine, German Cancer Research Center (DKFZ), Heidelberg, Germany
| | - Hans-Ulrich Kauczor
- Translational Lung Research Center Heidelberg, Member of the German Center for Lung Research DZL, Heidelberg, Germany.,Department of Diagnostic and Interventional Radiology, University Hospital Heidelberg, Heidelberg, Germany
| | - Uwe Haberkorn
- Department of Nuclear Medicine, University Hospital Heidelberg, Heidelberg, Germany.,Translational Lung Research Center Heidelberg, Member of the German Center for Lung Research DZL, Heidelberg, Germany.,Clinical Cooperation Unit, Department of Nuclear Medicine, German Cancer Research Center (DKFZ), Heidelberg, Germany
| | - Claus Peter Heussel
- Translational Lung Research Center Heidelberg, Member of the German Center for Lung Research DZL, Heidelberg, Germany.,Division of Diagnostic and Interventional Radiology with Nuclear Medicine, Thorax Clinic, University of Heidelberg, Heidelberg, Germany
| | - Monika Eichinger
- Translational Lung Research Center Heidelberg, Member of the German Center for Lung Research DZL, Heidelberg, Germany.,Division of Diagnostic and Interventional Radiology with Nuclear Medicine, Thorax Clinic, University of Heidelberg, Heidelberg, Germany
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37
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Wälscher J, Groß B, Eberhardt R, Heussel CP, Eichinger M, Warth A, Lasitschka F, Herth FJF, Kreuter M. Transbronchial Cryobiopsies for Diagnosing Interstitial Lung Disease: Real-Life Experience from a Tertiary Referral Center for Interstitial Lung Disease. Respiration 2018; 97:348-354. [PMID: 30554201 DOI: 10.1159/000493428] [Citation(s) in RCA: 29] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2018] [Accepted: 08/30/2018] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND Transbronchial cryobiopsy (cTBB) may offer an alternative to surgical lung biopsy (SLB) for histopathological diagnosis of interstitial lung diseases (ILDs). However, real-life experience is limited, although case series are increasingly reported. OBJECTIVES We aimed to evaluate the value of cTBB performed under real-life conditions in a tertiary care center for ILDs. METHODS Data on all patients undergoing a cTBB for evaluation of suspected ILD between October 2015 and January 2017 were included in this retrospective case series. Procedure details, complication rates, histopathological results, and diagnostic consensus reached by a multidisciplinary team (MDT) discussion were collated and evaluated. RESULTS A total of 109 patients (mean age 64 years, range 19-85; 66% male, 38% never smokers) referred to our center with features suggestive of ILD underwent cTBB. The mean FVC% predicted was 77% (range 41-131), with a mean DLCO of 51% (range 20-86), and a 6-min walking test (6MWT) of 402 m (range 100-642). On average, 4 samples were taken from each patient (range 1-8), with a mean biopsy diameter of 5 mm (range 2-12). Complications included pneumothorax (11.9%), all treated with chest drain. Moderate bleeding occurred in 28.4% (all resolved without active measures). No acute disease exacerbations and no deaths occurred. A histopathological pattern diagnosis was possible in 80 cases (73.4%), and 26.6% of cases were considered nonspecific. An MDT consensus diagnosis was reached in 83.5% of cases. Subsequent SLB was proposed in 13 cases and performed in 8 cases. CONCLUSIONS In the real-world setting, cTBB has a meaningful diagnostic value in the context of a MDT approach and may enable histopathological assessment even in patients with more advanced disease unsuitable for SLB.
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Affiliation(s)
- Julia Wälscher
- Center for Interstitial and Rare Lung Diseases, Thoraxklinik, University of Heidelberg, Heidelberg, Germany.,Pneumology and Respiratory Critical Care Medicine, Thoraxklinik, University of Heidelberg, Heidelberg, Germany
| | - Benjamin Groß
- Center for Interstitial and Rare Lung Diseases, Thoraxklinik, University of Heidelberg, Heidelberg, Germany
| | - Ralf Eberhardt
- Pneumology and Respiratory Critical Care Medicine, Thoraxklinik, University of Heidelberg, Heidelberg, Germany.,Translational Lung Research Center Heidelberg (TLRCH), German Center for Lung Research (DZL), Heidelberg, Germany
| | - Claus Peter Heussel
- Translational Lung Research Center Heidelberg (TLRCH), German Center for Lung Research (DZL), Heidelberg, Germany.,Diagnostic and Interventional Radiology with Nuclear Medicine, Thoraxklinik, University of Heidelberg, Heidelberg, Germany.,Diagnostic and Interventional Radiology, University of Heidelberg, Heidelberg, Germany
| | - Monika Eichinger
- Translational Lung Research Center Heidelberg (TLRCH), German Center for Lung Research (DZL), Heidelberg, Germany.,Diagnostic and Interventional Radiology with Nuclear Medicine, Thoraxklinik, University of Heidelberg, Heidelberg, Germany
| | - Arne Warth
- Institute of Pathology, Cytology and Molecular Pathology, Giessen/Wetzlar/Limburg, Germany
| | - Felix Lasitschka
- Translational Lung Research Center Heidelberg (TLRCH), German Center for Lung Research (DZL), Heidelberg, Germany.,Institute of Pathology, University of Heidelberg, Heidelberg, Germany
| | - Felix J F Herth
- Pneumology and Respiratory Critical Care Medicine, Thoraxklinik, University of Heidelberg, Heidelberg, Germany.,Translational Lung Research Center Heidelberg (TLRCH), German Center for Lung Research (DZL), Heidelberg, Germany
| | - Michael Kreuter
- Center for Interstitial and Rare Lung Diseases, Thoraxklinik, University of Heidelberg, Heidelberg, Germany, .,Pneumology and Respiratory Critical Care Medicine, Thoraxklinik, University of Heidelberg, Heidelberg, Germany, .,Translational Lung Research Center Heidelberg (TLRCH), German Center for Lung Research (DZL), Heidelberg, Germany,
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38
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Jobst BJ, Owsijewitsch M, Kauczor HU, Biederer J, Ley S, Becker N, Kopp-Schneider A, Delorme S, Heussel CP, Puderbach M, Wielpütz MO, Ley-Zaporozhan J. GOLD stage predicts thoracic aortic calcifications in patients with COPD. Exp Ther Med 2018; 17:967-973. [PMID: 30651888 DOI: 10.3892/etm.2018.7039] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2018] [Accepted: 11/21/2018] [Indexed: 12/22/2022] Open
Abstract
Although some of the associations between chronic obstructive pulmonary disease (COPD) and atherosclerosis are based on shared risk factors such as smoking, recent epidemiological evidence suggests that COPD is a risk factor for vascular disease due to systemic inflammation. The present study assessed the hypothesis that disease severity (as expressed by the GOLD stage) independently predicts the extent of vascular calcifications. A total of 160 smokers diagnosed with COPD (GOLD I-IV, 40 subjects of each GOLD stage) and 40 smokers at risk (GOLD 0; median age of 60 years old; Q1:56;Q3:65; 135 males and 65 females) underwent non-contrast, non-electrocardiography synchronized chest computerised tomography. The volume of thoracic aortic calcifications was quantified semi-automatically within a region from T1 through T12. Multiparametric associations with GOLD stage, smoking history, sex, age, body mass index and emphysema index were evaluated using generalized linear regression analysis. Thoracic aortic calcifications were highly prevalent in this cohort (187/200 subjects, 709 (Q1:109;Q3:2163) mm3). Analysis of variance on ranks demonstrated a significant difference in calcium between different GOLD-stages as well as patients at risk of COPD (F=36.8, P<0.001). In the multivariable analysis, GOLD-stages were indicated to be predictive of thoracic aortic calcifications (P≤0.0033) besides age (P<0.0001), while age appeared to be the strongest predictor. Other variables were not statistically linked to thoracic aortic calcifications in the multivariable model. COPD severity, as expressed by the GOLD-stage, is a significant predictor of thoracic aortic calcifications, independent of covariates such as age or tobacco consumption.
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Affiliation(s)
- Bertram J Jobst
- Department of Diagnostic and Interventional Radiology, University Hospital Heidelberg, D-69120 Heidelberg, Germany.,Translational Lung Research Centre Heidelberg (TLRC), Member of The German Lung Research Centre (DZL), D-69120 Heidelberg, Germany.,Department of Diagnostic and Interventional Radiology with Nuclear Medicine, Thoraxklinik at University of Heidelberg, D-69126 Heidelberg, Germany
| | - Michael Owsijewitsch
- Department of Diagnostic and Interventional Radiology, University Hospital Heidelberg, D-69120 Heidelberg, Germany.,Translational Lung Research Centre Heidelberg (TLRC), Member of The German Lung Research Centre (DZL), D-69120 Heidelberg, Germany.,Department of Diagnostic and Interventional Radiology with Nuclear Medicine, Thoraxklinik at University of Heidelberg, D-69126 Heidelberg, Germany
| | - Hans-Ulrich Kauczor
- Department of Diagnostic and Interventional Radiology, University Hospital Heidelberg, D-69120 Heidelberg, Germany.,Translational Lung Research Centre Heidelberg (TLRC), Member of The German Lung Research Centre (DZL), D-69120 Heidelberg, Germany.,Department of Diagnostic and Interventional Radiology with Nuclear Medicine, Thoraxklinik at University of Heidelberg, D-69126 Heidelberg, Germany
| | - Jürgen Biederer
- Department of Diagnostic and Interventional Radiology, University Hospital Heidelberg, D-69120 Heidelberg, Germany.,Department of Diagnostic and Interventional Radiology with Nuclear Medicine, Thoraxklinik at University of Heidelberg, D-69126 Heidelberg, Germany.,Department of Radiology, Hospital Gross-Gerau, Darmstadt Private Practice for Radiology and Nuclear Medicine, D-64521 Gross-Gerau, Germany
| | - Sebastian Ley
- Department of Diagnostic and Interventional Radiology, University Hospital Heidelberg, D-69120 Heidelberg, Germany.,Diagnostic and Interventional Radiology, Surgical Hospital Munich South, D-81379 Munich, Germany
| | - Nikolaus Becker
- Division of Cancer Epidemiology, German Cancer Research Centre (DKFZ Heidelberg), D-69120 Heidelberg, Germany
| | | | - Stefan Delorme
- Department of Radiology, German Cancer Research Centre (DKFZ Heidelberg), D-69120 Heidelberg, Germany
| | - Claus Peter Heussel
- Department of Diagnostic and Interventional Radiology, University Hospital Heidelberg, D-69120 Heidelberg, Germany.,Translational Lung Research Centre Heidelberg (TLRC), Member of The German Lung Research Centre (DZL), D-69120 Heidelberg, Germany.,Department of Diagnostic and Interventional Radiology with Nuclear Medicine, Thoraxklinik at University of Heidelberg, D-69126 Heidelberg, Germany
| | - Michael Puderbach
- Department of Diagnostic and Interventional Radiology with Nuclear Medicine, Thoraxklinik at University of Heidelberg, D-69126 Heidelberg, Germany.,Department of Diagnostic and Interventional Radiology, Hufeland Hospital, D-99947 Bad Langensalza, Germany
| | - Mark O Wielpütz
- Department of Diagnostic and Interventional Radiology, University Hospital Heidelberg, D-69120 Heidelberg, Germany.,Translational Lung Research Centre Heidelberg (TLRC), Member of The German Lung Research Centre (DZL), D-69120 Heidelberg, Germany.,Department of Diagnostic and Interventional Radiology with Nuclear Medicine, Thoraxklinik at University of Heidelberg, D-69126 Heidelberg, Germany
| | - Julia Ley-Zaporozhan
- Department of Diagnostic and Interventional Radiology, University Hospital Heidelberg, D-69120 Heidelberg, Germany.,Department of Radiology, Ludwig-Maximilians-University Hospital Munich, D-80337 Munich, Germany
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39
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Gompelmann D, Benjamin N, Bischoff E, Kontogianni K, Schuhmann M, Hoffmann H, Heussel CP, Herth FJF, Eberhardt R. Survival after Endoscopic Valve Therapy in Patients with Severe Emphysema. Respiration 2018; 97:145-152. [PMID: 30227420 DOI: 10.1159/000492274] [Citation(s) in RCA: 34] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2018] [Accepted: 07/16/2018] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND Endoscopic valve therapy leads to an improvement of lung function, exercise tolerance, and quality of life in a selected cohort of patients with advanced emphysema. So far, only few data exist on the long-term outcome. OBJECTIVES This analysis evaluated the impact of valve therapy on the survival of emphysema patients. METHODS Survival rates of emphysema patients who underwent valve therapy were assessed according to their radiological outcome following valve placement. RESULTS From 2005 to 2013, 449 emphysema patients (mean age 64 ± 7 years) underwent valve therapy and were followed for a mean time of 37.3 ± 21.3 months. A total of 128 patients (29%) developed complete lobar atelectasis, 34 out of these also experienced a pneumothorax; 50 patients (11%) developed pneumothorax without lobar atelectasis, and 261 patients (58%) target lobe volume reduction or no volume change. Patients with atelectasis showed significantly better baseline forced expiratory volume in 1 second (%), residual volume (L), total lung capacity (L), and transfer factor for carbon monoxide (%; all p < 0.05), but there was no significant difference in the BODE score (p = 0.195). Patients with valve-induced lobar atelectasis had a significant survival benefit compared to patients without atelectasis (p = 0.009; 5-year survival rate 65.3 vs. 43.9%). The advent of pneumothorax in 84 patients did not influence survival (p = 0.52). CONCLUSIONS Lobar atelectasis following endoscopic valve therapy is associated with a survival benefit.
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Affiliation(s)
- Daniela Gompelmann
- Pneumology and Critical Care Medicine, Thoraxklinik, University of Heidelberg, Heidelberg, .,Translational Lung Research Center Heidelberg (TLRCH), German Center for Lung Research, Heidelberg,
| | - Nicola Benjamin
- Pneumology and Critical Care Medicine, Thoraxklinik, University of Heidelberg, Heidelberg, Germany
| | - Elena Bischoff
- Pneumology and Critical Care Medicine, Thoraxklinik, University of Heidelberg, Heidelberg, Germany
| | - Konstantina Kontogianni
- Pneumology and Critical Care Medicine, Thoraxklinik, University of Heidelberg, Heidelberg, Germany.,Translational Lung Research Center Heidelberg (TLRCH), German Center for Lung Research, Heidelberg, Germany
| | - Maren Schuhmann
- Pneumology and Critical Care Medicine, Thoraxklinik, University of Heidelberg, Heidelberg, Germany
| | - Hans Hoffmann
- Translational Lung Research Center Heidelberg (TLRCH), German Center for Lung Research, Heidelberg, Germany.,Thoracic Surgery, Thoraxklinik, University of Heidelberg, Heidelberg, Germany
| | - Claus Peter Heussel
- Translational Lung Research Center Heidelberg (TLRCH), German Center for Lung Research, Heidelberg, Germany.,Diagnostic and Interventional Radiology with Nuclear Medicine, Thoraxklinik, University of Heidelberg, Heidelberg, Germany
| | - Felix J F Herth
- Pneumology and Critical Care Medicine, Thoraxklinik, University of Heidelberg, Heidelberg, Germany.,Translational Lung Research Center Heidelberg (TLRCH), German Center for Lung Research, Heidelberg, Germany
| | - Ralf Eberhardt
- Pneumology and Critical Care Medicine, Thoraxklinik, University of Heidelberg, Heidelberg, Germany.,Translational Lung Research Center Heidelberg (TLRCH), German Center for Lung Research, Heidelberg, Germany
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40
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Kontogianni K, Russell K, Eberhardt R, Schuhmann M, Heussel CP, Wood S, Herth FJ, Gompelmann D. Clinical and quantitative computed tomography predictors of response to endobronchial lung volume reduction therapy using coils. Int J Chron Obstruct Pulmon Dis 2018; 13:2215-2223. [PMID: 30050294 PMCID: PMC6055902 DOI: 10.2147/copd.s159355] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/04/2022] Open
Abstract
Objectives Bronchoscopic lung volume reduction using coils (LVRC) is a well-known treatment option for severe emphysema. The purpose of this study was to identify quantitative computed tomography (QCT) and clinical parameters associated with positive treatment outcome. Patients and methods The CT scans, pulmonary function tests (PFT), and 6-minute walk test (6-MWT) data were collected from 72 patients with advanced emphysema prior to and at 3 months after LVRC treatment. The procedure involved placing 10 coils unilaterally. Various QCT parameters were derived using Apollo imaging software (VIDA). Independent predictors of clinically relevant outcome (Δ6-MWT ≥ 26 m, ΔFEV1 ≥ 12%, ΔRV ≥ 10%) were identified through stepwise linear regression analysis. Results The response outcome for Δ6-MWT, for ΔFEV1 and for ΔRV was met by 55%, 32% and 42%, respectively. For Δ6-MWT ≥ 26 m a lower baseline 6-MWT (p = 0.0003) and a larger standard deviation (SD) of low attenuation cluster (LAC) sizes in peripheral regions of treated lung (p = 0.0037) were significantly associated with positive outcome. For ΔFEV1 ≥ 12%, lower baseline FEV1 (p = 0.02) and larger median LAC sizes in the central regions of treated lobe (p = 0.0018) were significant predictors of good response. For ΔRV ≥ 10% a greater baseline TLC (p = 0.0014) and a larger SD of LAC sizes in peripheral regions of treated lung (p = 0.007) tended to respond better. Conclusion Patients with lower FEV1 and 6-MWT, with higher TLC and specific QCT characteristics responded more positively to LVRC treatment, suggesting a more targeted CT-based approach to patient selection could lead to greater efficacy in treatment response.
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Affiliation(s)
- Konstantina Kontogianni
- Department of Pulmonology and Respiratory Care Medicine, Thoraxklinik at the University of Heidelberg, Heidelberg, Germany, .,Translational Lung Research Center Heidelberg, Member of the German Center for Lung Research DZL, Heidelberg, Germany,
| | | | - Ralf Eberhardt
- Department of Pulmonology and Respiratory Care Medicine, Thoraxklinik at the University of Heidelberg, Heidelberg, Germany, .,Translational Lung Research Center Heidelberg, Member of the German Center for Lung Research DZL, Heidelberg, Germany,
| | - Maren Schuhmann
- Department of Pulmonology and Respiratory Care Medicine, Thoraxklinik at the University of Heidelberg, Heidelberg, Germany, .,Translational Lung Research Center Heidelberg, Member of the German Center for Lung Research DZL, Heidelberg, Germany,
| | - Claus Peter Heussel
- Translational Lung Research Center Heidelberg, Member of the German Center for Lung Research DZL, Heidelberg, Germany, .,Diagnostic and Interventional Radiology with Nuclear Medicine, Chest Clinic (Thoraxklinik), University of Heidelberg, Heidelberg, Germany
| | | | - Felix Jf Herth
- Department of Pulmonology and Respiratory Care Medicine, Thoraxklinik at the University of Heidelberg, Heidelberg, Germany, .,Translational Lung Research Center Heidelberg, Member of the German Center for Lung Research DZL, Heidelberg, Germany,
| | - Daniela Gompelmann
- Department of Pulmonology and Respiratory Care Medicine, Thoraxklinik at the University of Heidelberg, Heidelberg, Germany, .,Translational Lung Research Center Heidelberg, Member of the German Center for Lung Research DZL, Heidelberg, Germany,
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41
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Ullmann AJ, Aguado JM, Arikan-Akdagli S, Denning DW, Groll AH, Lagrou K, Lass-Flörl C, Lewis RE, Munoz P, Verweij PE, Warris A, Ader F, Akova M, Arendrup MC, Barnes RA, Beigelman-Aubry C, Blot S, Bouza E, Brüggemann RJM, Buchheidt D, Cadranel J, Castagnola E, Chakrabarti A, Cuenca-Estrella M, Dimopoulos G, Fortun J, Gangneux JP, Garbino J, Heinz WJ, Herbrecht R, Heussel CP, Kibbler CC, Klimko N, Kullberg BJ, Lange C, Lehrnbecher T, Löffler J, Lortholary O, Maertens J, Marchetti O, Meis JF, Pagano L, Ribaud P, Richardson M, Roilides E, Ruhnke M, Sanguinetti M, Sheppard DC, Sinkó J, Skiada A, Vehreschild MJGT, Viscoli C, Cornely OA. Diagnosis and management of Aspergillus diseases: executive summary of the 2017 ESCMID-ECMM-ERS guideline. Clin Microbiol Infect 2018; 24 Suppl 1:e1-e38. [PMID: 29544767 DOI: 10.1016/j.cmi.2018.01.002] [Citation(s) in RCA: 780] [Impact Index Per Article: 130.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2017] [Revised: 01/02/2018] [Accepted: 01/03/2018] [Indexed: 02/06/2023]
Abstract
The European Society for Clinical Microbiology and Infectious Diseases, the European Confederation of Medical Mycology and the European Respiratory Society Joint Clinical Guidelines focus on diagnosis and management of aspergillosis. Of the numerous recommendations, a few are summarized here. Chest computed tomography as well as bronchoscopy with bronchoalveolar lavage (BAL) in patients with suspicion of pulmonary invasive aspergillosis (IA) are strongly recommended. For diagnosis, direct microscopy, preferably using optical brighteners, histopathology and culture are strongly recommended. Serum and BAL galactomannan measures are recommended as markers for the diagnosis of IA. PCR should be considered in conjunction with other diagnostic tests. Pathogen identification to species complex level is strongly recommended for all clinically relevant Aspergillus isolates; antifungal susceptibility testing should be performed in patients with invasive disease in regions with resistance found in contemporary surveillance programmes. Isavuconazole and voriconazole are the preferred agents for first-line treatment of pulmonary IA, whereas liposomal amphotericin B is moderately supported. Combinations of antifungals as primary treatment options are not recommended. Therapeutic drug monitoring is strongly recommended for patients receiving posaconazole suspension or any form of voriconazole for IA treatment, and in refractory disease, where a personalized approach considering reversal of predisposing factors, switching drug class and surgical intervention is also strongly recommended. Primary prophylaxis with posaconazole is strongly recommended in patients with acute myelogenous leukaemia or myelodysplastic syndrome receiving induction chemotherapy. Secondary prophylaxis is strongly recommended in high-risk patients. We strongly recommend treatment duration based on clinical improvement, degree of immunosuppression and response on imaging.
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Affiliation(s)
- A J Ullmann
- Department of Infectious Diseases, Haematology and Oncology, University Hospital Würzburg, Würzburg, Germany; ESCMID Fungal Infection Study Group (EFISG); European Confederation of Medical Mycology (ECMM)
| | - J M Aguado
- Infectious Diseases Unit, University Hospital Madrid, Madrid, Spain; ESCMID Fungal Infection Study Group (EFISG); European Confederation of Medical Mycology (ECMM)
| | - S Arikan-Akdagli
- Department of Medical Microbiology, Hacettepe University Medical School, Ankara, Turkey; ESCMID Fungal Infection Study Group (EFISG); European Confederation of Medical Mycology (ECMM)
| | - D W Denning
- The National Aspergillosis Centre, Wythenshawe Hospital, Mycology Reference Centre Manchester, Manchester University NHS Foundation Trust, ECMM Excellence Centre of Medical Mycology, Manchester, UK; The University of Manchester, Manchester, UK; Manchester Academic Health Science Centre, Manchester, UK; European Confederation of Medical Mycology (ECMM)
| | - A H Groll
- Department of Paediatric Haematology/Oncology, Centre for Bone Marrow Transplantation, University Children's Hospital Münster, Münster, Germany; ESCMID Fungal Infection Study Group (EFISG); European Confederation of Medical Mycology (ECMM)
| | - K Lagrou
- Department of Microbiology and Immunology, ECMM Excellence Centre of Medical Mycology, University Hospital Leuven, Leuven, Belgium; ESCMID Fungal Infection Study Group (EFISG); European Confederation of Medical Mycology (ECMM)
| | - C Lass-Flörl
- Institute of Hygiene, Microbiology and Social Medicine, ECMM Excellence Centre of Medical Mycology, Medical University Innsbruck, Innsbruck, Austria; ESCMID Fungal Infection Study Group (EFISG); European Confederation of Medical Mycology (ECMM)
| | - R E Lewis
- Infectious Diseases Clinic, Sant'Orsola-Malpighi Hospital, University of Bologna, Bologna, Italy; ESCMID Fungal Infection Study Group (EFISG)
| | - P Munoz
- Department of Medical Microbiology and Infectious Diseases, Hospital General Universitario Gregorio Marañón, Madrid, Spain; CIBER Enfermedades Respiratorias - CIBERES (CB06/06/0058), Madrid, Spain; Medicine Department, School of Medicine, Universidad Complutense de Madrid, Madrid, Spain; ESCMID Fungal Infection Study Group (EFISG); European Confederation of Medical Mycology (ECMM)
| | - P E Verweij
- Department of Medical Microbiology, Radboud University Medical Centre, Centre of Expertise in Mycology Radboudumc/CWZ, ECMM Excellence Centre of Medical Mycology, Nijmegen, Netherlands; ESCMID Fungal Infection Study Group (EFISG); European Confederation of Medical Mycology (ECMM)
| | - A Warris
- MRC Centre for Medical Mycology, Institute of Medical Sciences, University of Aberdeen, Aberdeen, UK; ESCMID Fungal Infection Study Group (EFISG); European Confederation of Medical Mycology (ECMM)
| | - F Ader
- Department of Infectious Diseases, Hospices Civils de Lyon, Lyon, France; Inserm 1111, French International Centre for Infectious Diseases Research (CIRI), Université Claude Bernard Lyon 1, Lyon, France; European Respiratory Society (ERS)
| | - M Akova
- Department of Medicine, Section of Infectious Diseases, Hacettepe University Medical School, Ankara, Turkey; ESCMID Fungal Infection Study Group (EFISG); European Confederation of Medical Mycology (ECMM)
| | - M C Arendrup
- Department Microbiological Surveillance and Research, Statens Serum Institute, Copenhagen, Denmark; ESCMID Fungal Infection Study Group (EFISG); European Confederation of Medical Mycology (ECMM)
| | - R A Barnes
- Department of Medical Microbiology and Infectious Diseases, Institute of Infection and Immunity, School of Medicine, Cardiff University, Cardiff, UK; European Confederation of Medical Mycology (ECMM)
| | - C Beigelman-Aubry
- Department of Diagnostic and Interventional Radiology, Centre Hospitalier Universitaire Vaudois (CHUV), Lausanne, Switzerland; European Respiratory Society (ERS)
| | - S Blot
- Department of Internal Medicine, Ghent University, Ghent, Belgium; Burns, Trauma and Critical Care Research Centre, University of Queensland, Brisbane, Australia; European Respiratory Society (ERS)
| | - E Bouza
- Department of Medical Microbiology and Infectious Diseases, Hospital General Universitario Gregorio Marañón, Madrid, Spain; CIBER Enfermedades Respiratorias - CIBERES (CB06/06/0058), Madrid, Spain; Medicine Department, School of Medicine, Universidad Complutense de Madrid, Madrid, Spain; ESCMID Fungal Infection Study Group (EFISG); European Confederation of Medical Mycology (ECMM)
| | - R J M Brüggemann
- Radboud Centre for Infectious Diseases, Radboud University Medical Centre, Centre of Expertise in Mycology Radboudumc/CWZ, ECMM Excellence Centre of Medical Mycology, Nijmegen, Netherlands; ESCMID Fungal Infection Study Group (EFISG)
| | - D Buchheidt
- Medical Clinic III, University Hospital Mannheim, Mannheim, Germany; ESCMID Fungal Infection Study Group (EFISG); European Confederation of Medical Mycology (ECMM)
| | - J Cadranel
- Department of Pneumology, University Hospital of Tenon and Sorbonne, University of Paris, Paris, France; European Respiratory Society (ERS)
| | - E Castagnola
- Infectious Diseases Unit, Istituto Giannina Gaslini Children's Hospital, Genoa, Italy; ESCMID Fungal Infection Study Group (EFISG)
| | - A Chakrabarti
- Department of Medical Microbiology, Postgraduate Institute of Medical Education & Research, Chandigarh, India; European Confederation of Medical Mycology (ECMM)
| | - M Cuenca-Estrella
- Instituto de Salud Carlos III, Madrid, Spain; ESCMID Fungal Infection Study Group (EFISG); European Confederation of Medical Mycology (ECMM)
| | - G Dimopoulos
- Department of Critical Care Medicine, Attikon University Hospital, National and Kapodistrian University of Athens, Medical School, Athens, Greece; European Respiratory Society (ERS)
| | - J Fortun
- Infectious Diseases Service, Ramón y Cajal Hospital, Madrid, Spain; ESCMID Fungal Infection Study Group (EFISG); European Confederation of Medical Mycology (ECMM)
| | - J-P Gangneux
- Univ Rennes, CHU Rennes, Inserm, Irset (Institut de Recherche en santé, environnement et travail) - UMR_S 1085, Rennes, France; ESCMID Fungal Infection Study Group (EFISG); European Confederation of Medical Mycology (ECMM)
| | - J Garbino
- Division of Infectious Diseases, University Hospital of Geneva, Geneva, Switzerland; ESCMID Fungal Infection Study Group (EFISG); European Confederation of Medical Mycology (ECMM)
| | - W J Heinz
- Department of Infectious Diseases, Haematology and Oncology, University Hospital Würzburg, Würzburg, Germany; ESCMID Fungal Infection Study Group (EFISG); European Confederation of Medical Mycology (ECMM)
| | - R Herbrecht
- Department of Haematology and Oncology, University Hospital of Strasbourg, Strasbourg, France; ESCMID Fungal Infection Study Group (EFISG)
| | - C P Heussel
- Diagnostic and Interventional Radiology, Thoracic Clinic, University Hospital Heidelberg, Heidelberg, Germany; European Confederation of Medical Mycology (ECMM)
| | - C C Kibbler
- Centre for Medical Microbiology, University College London, London, UK; European Confederation of Medical Mycology (ECMM)
| | - N Klimko
- Department of Clinical Mycology, Allergy and Immunology, North Western State Medical University, St Petersburg, Russia; European Confederation of Medical Mycology (ECMM)
| | - B J Kullberg
- Radboud Centre for Infectious Diseases, Radboud University Medical Centre, Centre of Expertise in Mycology Radboudumc/CWZ, ECMM Excellence Centre of Medical Mycology, Nijmegen, Netherlands; ESCMID Fungal Infection Study Group (EFISG); European Confederation of Medical Mycology (ECMM)
| | - C Lange
- International Health and Infectious Diseases, University of Lübeck, Lübeck, Germany; Clinical Infectious Diseases, Research Centre Borstel, Leibniz Center for Medicine & Biosciences, Borstel, Germany; German Centre for Infection Research (DZIF), Tuberculosis Unit, Hamburg-Lübeck-Borstel-Riems Site, Lübeck, Germany; European Respiratory Society (ERS)
| | - T Lehrnbecher
- Division of Paediatric Haematology and Oncology, Hospital for Children and Adolescents, Johann Wolfgang Goethe-University, Frankfurt, Germany; European Confederation of Medical Mycology (ECMM)
| | - J Löffler
- Department of Infectious Diseases, Haematology and Oncology, University Hospital Würzburg, Würzburg, Germany; ESCMID Fungal Infection Study Group (EFISG); European Confederation of Medical Mycology (ECMM)
| | - O Lortholary
- Department of Infectious and Tropical Diseases, Children's Hospital, University of Paris, Paris, France; ESCMID Fungal Infection Study Group (EFISG); European Confederation of Medical Mycology (ECMM)
| | - J Maertens
- Department of Haematology, ECMM Excellence Centre of Medical Mycology, University Hospital Leuven, Leuven, Belgium; ESCMID Fungal Infection Study Group (EFISG); European Confederation of Medical Mycology (ECMM)
| | - O Marchetti
- Infectious Diseases Service, Department of Medicine, Lausanne University Hospital, Lausanne, Switzerland; Department of Medicine, Ensemble Hospitalier de la Côte, Morges, Switzerland; ESCMID Fungal Infection Study Group (EFISG); European Confederation of Medical Mycology (ECMM)
| | - J F Meis
- Department of Medical Microbiology and Infectious Diseases, Canisius-Wilhelmina Hospital, Centre of Expertise in Mycology Radboudumc/CWZ, ECMM Excellence Centre of Medical Mycology, Nijmegen, Netherlands; ESCMID Fungal Infection Study Group (EFISG); European Confederation of Medical Mycology (ECMM)
| | - L Pagano
- Department of Haematology, Universita Cattolica del Sacro Cuore, Roma, Italy; European Confederation of Medical Mycology (ECMM)
| | - P Ribaud
- Quality Unit, Pôle Prébloc, Saint-Louis and Lariboisière Hospital Group, Assistance Publique-Hôpitaux de Paris, Paris, France
| | - M Richardson
- The National Aspergillosis Centre, Wythenshawe Hospital, Mycology Reference Centre Manchester, Manchester University NHS Foundation Trust, ECMM Excellence Centre of Medical Mycology, Manchester, UK; The University of Manchester, Manchester, UK; Manchester Academic Health Science Centre, Manchester, UK; ESCMID Fungal Infection Study Group (EFISG); European Confederation of Medical Mycology (ECMM)
| | - E Roilides
- Infectious Diseases Unit, 3rd Department of Paediatrics, Faculty of Medicine, Aristotle University School of Health Sciences, Thessaloniki, Greece; Hippokration General Hospital, Thessaloniki, Greece; ESCMID Fungal Infection Study Group (EFISG); European Confederation of Medical Mycology (ECMM)
| | - M Ruhnke
- Department of Haematology and Oncology, Paracelsus Hospital, Osnabrück, Germany; ESCMID Fungal Infection Study Group (EFISG); European Confederation of Medical Mycology (ECMM)
| | - M Sanguinetti
- Institute of Microbiology, Fondazione Policlinico Universitario A. Gemelli - Università Cattolica del Sacro Cuore, Rome, Italy; ESCMID Fungal Infection Study Group (EFISG); European Confederation of Medical Mycology (ECMM)
| | - D C Sheppard
- Division of Infectious Diseases, Department of Medicine, Microbiology and Immunology, McGill University, Montreal, Canada; ESCMID Fungal Infection Study Group (EFISG); European Confederation of Medical Mycology (ECMM)
| | - J Sinkó
- Department of Haematology and Stem Cell Transplantation, Szent István and Szent László Hospital, Budapest, Hungary; ESCMID Fungal Infection Study Group (EFISG)
| | - A Skiada
- First Department of Medicine, Laiko Hospital, National and Kapodistrian University of Athens, Athens, Greece; ESCMID Fungal Infection Study Group (EFISG); European Confederation of Medical Mycology (ECMM)
| | - M J G T Vehreschild
- Department I of Internal Medicine, ECMM Excellence Centre of Medical Mycology, University Hospital of Cologne, Cologne, Germany; Centre for Integrated Oncology, Cologne-Bonn, University of Cologne, Cologne, Germany; German Centre for Infection Research (DZIF) partner site Bonn-Cologne, Cologne, Germany; European Confederation of Medical Mycology (ECMM)
| | - C Viscoli
- Ospedale Policlinico San Martino and University of Genova (DISSAL), Genova, Italy; ESCMID Fungal Infection Study Group (EFISG); European Confederation of Medical Mycology (ECMM)
| | - O A Cornely
- First Department of Medicine, Laiko Hospital, National and Kapodistrian University of Athens, Athens, Greece; German Centre for Infection Research (DZIF) partner site Bonn-Cologne, Cologne, Germany; CECAD Cluster of Excellence, University of Cologne, Cologne, Germany; Clinical Trials Center Cologne, University Hospital of Cologne, Cologne, Germany; ESCMID Fungal Infection Study Group (EFISG); European Confederation of Medical Mycology (ECMM); ESCMID European Study Group for Infections in Compromised Hosts (ESGICH).
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Brunnemer E, Wälscher J, Tenenbaum S, Hausmanns J, Schulze K, Seiter M, Heussel CP, Warth A, Herth FJF, Kreuter M. Real-World Experience with Nintedanib in Patients with Idiopathic Pulmonary Fibrosis. Respiration 2018; 95:301-309. [PMID: 29490307 DOI: 10.1159/000485933] [Citation(s) in RCA: 56] [Impact Index Per Article: 9.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2017] [Accepted: 11/29/2017] [Indexed: 12/31/2022] Open
Abstract
BACKGROUND Nintedanib, an oral tyrosine kinase inhibitor, has been shown to slow down the progression of idiopathic pulmonary fibrosis (IPF) in two randomised placebo-controlled trials by reducing the annual decline in forced vital capacity (FVC). However, real-world experience is limited. OBJECTIVE To assess the efficacy and safety of nintedanib in a large cohort of patients treated at a tertiary referral site for interstitial lung diseases. METHODS The records of patients with a confirmed diagnosis of IPF were reviewed. Full medical history, pulmonary function, and adverse events (AEs) were recorded from each clinic visit. Disease progression was defined as a reduction in FVC ≥5% and/or in diffusing capacity of the lung for carbon monoxide ≥15% according to recent publications. Only patients with a treatment duration ≥3 months were included in the efficacy evaluation. RESULTS A total of 64 patients were treated. Mean ± standard deviation (SD) FVC was 71 ± 21% predicted, and the mean time from diagnosis to initiation of nintedanib treatment was 23.8 months. Nearly half of patients (n = 30, 47%) had received prior pirfenidone treatment. The mean duration of follow-up was 11 months. At 6 months following initiation of nintedanib, 67% of the patients were stable. The mean ± SD change in percent predicted FVC from baseline was 0.2 ± 7.8% at 3 months, -1.3 ± 7.9% at 6 months, and -2.1 ± 9% at 9 months. Diarrhoea was the most common AE experienced by 33% of patients and was generally manageable. CONCLUSION The results from this real-world clinical setting support findings from previously conducted clinical trials and show that nintedanib is effective for the management of IPF and is associated with disease stabilisation. Nintedanib is generally well tolerated.
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Affiliation(s)
- Eva Brunnemer
- Centre for Interstitial and Rare Lung Diseases, Department of Pneumology and Respiratory Critical Care Medicine, Thoraxklinik, University of Heidelberg, Heidelberg, Germany.,Translational Lung Research Centre Heidelberg (TLRC), Member of the German Centre for Lung Research (DZL), Heidelberg, Germany
| | - Julia Wälscher
- Centre for Interstitial and Rare Lung Diseases, Department of Pneumology and Respiratory Critical Care Medicine, Thoraxklinik, University of Heidelberg, Heidelberg, Germany.,Translational Lung Research Centre Heidelberg (TLRC), Member of the German Centre for Lung Research (DZL), Heidelberg, Germany
| | - Svenja Tenenbaum
- Centre for Interstitial and Rare Lung Diseases, Department of Pneumology and Respiratory Critical Care Medicine, Thoraxklinik, University of Heidelberg, Heidelberg, Germany.,Translational Lung Research Centre Heidelberg (TLRC), Member of the German Centre for Lung Research (DZL), Heidelberg, Germany
| | - Julia Hausmanns
- Centre for Interstitial and Rare Lung Diseases, Department of Pneumology and Respiratory Critical Care Medicine, Thoraxklinik, University of Heidelberg, Heidelberg, Germany.,Translational Lung Research Centre Heidelberg (TLRC), Member of the German Centre for Lung Research (DZL), Heidelberg, Germany
| | - Karen Schulze
- Centre for Interstitial and Rare Lung Diseases, Department of Pneumology and Respiratory Critical Care Medicine, Thoraxklinik, University of Heidelberg, Heidelberg, Germany.,Translational Lung Research Centre Heidelberg (TLRC), Member of the German Centre for Lung Research (DZL), Heidelberg, Germany
| | - Marianne Seiter
- Centre for Interstitial and Rare Lung Diseases, Department of Pneumology and Respiratory Critical Care Medicine, Thoraxklinik, University of Heidelberg, Heidelberg, Germany.,Translational Lung Research Centre Heidelberg (TLRC), Member of the German Centre for Lung Research (DZL), Heidelberg, Germany
| | - Claus Peter Heussel
- Translational Lung Research Centre Heidelberg (TLRC), Member of the German Centre for Lung Research (DZL), Heidelberg, Germany.,Department of Diagnostic and Interventional Radiology with Nuclear Medicine, Thoraxklinik, University of Heidelberg, Heidelberg, Germany.,Department of Diagnostic and Interventional Radiology, University Hospital of Heidelberg, Heidelberg, Germany
| | - Arne Warth
- Translational Lung Research Centre Heidelberg (TLRC), Member of the German Centre for Lung Research (DZL), Heidelberg, Germany.,Institute of Pathology, University of Heidelberg, Heidelberg, Germany
| | - Felix J F Herth
- Centre for Interstitial and Rare Lung Diseases, Department of Pneumology and Respiratory Critical Care Medicine, Thoraxklinik, University of Heidelberg, Heidelberg, Germany.,Translational Lung Research Centre Heidelberg (TLRC), Member of the German Centre for Lung Research (DZL), Heidelberg, Germany
| | - Michael Kreuter
- Centre for Interstitial and Rare Lung Diseases, Department of Pneumology and Respiratory Critical Care Medicine, Thoraxklinik, University of Heidelberg, Heidelberg, Germany.,Translational Lung Research Centre Heidelberg (TLRC), Member of the German Centre for Lung Research (DZL), Heidelberg, Germany
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Gompelmann D, Kontogianni K, Schuhmann M, Eberhardt R, Heussel CP, Herth FJ. The minimal important difference for target lobe volume reduction after endoscopic valve therapy. Int J Chron Obstruct Pulmon Dis 2018; 13:465-472. [PMID: 29440884 PMCID: PMC5798552 DOI: 10.2147/copd.s152029] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
Objective Endoscopic valve therapy aims at target lobe volume reduction (TLVR) that is associated with improved lung function, exercise tolerance and quality of life in emphysema patients. So far, a TLVR of >350 mL was considered to be indicative of a positive response to treatment. However, it is not really known what amount of TLVR is crucial following valve implantation. Patients and methods TLVR, forced expiratory volume in 1 second (FEV1), residual volume (RV) and 6-minute walk distance (6-MWD) were assessed before and 3 months after valve implantation in 119 patients. TLVR was calculated based on computed tomography (CT) scan analysis using imaging software (Apollo; VIDA Diagnostics). Minimal important difference estimates were calculated by anchor-based and distribution-based methods. Results Patients treated with valves experienced a mean change of 0.11 L in FEV1, −0.51 L in RV, 44 m in 6-MWD and a TLVR of 945 mL. Using a linear regression and receiver operating characteristic analysis based on two of three anchors (ΔFEV1, ΔRV), the estimated minimal important difference for TLVR was between 890 and 1,070 mL (ie, 49%–54% of the baseline TLV). Conclusion In future, a TLVR between 49% and 54% of the baseline TLV, should be used when interpreting the clinical relevance.
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Affiliation(s)
- D Gompelmann
- Pneumology and Critical Care Medicine, Thoraxklinik at University of Heidelberg, Heidelberg.,Translational Lung Research Center Heidelberg (TLRCH), German Center for Lung Research, Heidelberg (DZL)
| | - K Kontogianni
- Pneumology and Critical Care Medicine, Thoraxklinik at University of Heidelberg, Heidelberg
| | - M Schuhmann
- Pneumology and Critical Care Medicine, Thoraxklinik at University of Heidelberg, Heidelberg
| | - R Eberhardt
- Pneumology and Critical Care Medicine, Thoraxklinik at University of Heidelberg, Heidelberg.,Translational Lung Research Center Heidelberg (TLRCH), German Center for Lung Research, Heidelberg (DZL)
| | - C P Heussel
- Translational Lung Research Center Heidelberg (TLRCH), German Center for Lung Research, Heidelberg (DZL).,Diagnostic and Interventional Radiology, Thoraxklinik at University of Heidelberg, Heidelberg.,Diagnostic and Interventional Radiology at University of Heidelberg, Heidelberg, Germany
| | - F J Herth
- Pneumology and Critical Care Medicine, Thoraxklinik at University of Heidelberg, Heidelberg.,Translational Lung Research Center Heidelberg (TLRCH), German Center for Lung Research, Heidelberg (DZL)
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Cornely OA, Leguay T, Maertens J, Vehreschild MJGT, Anagnostopoulos A, Castagnola C, Verga L, Rieger C, Kondakci M, Härter G, Duarte RF, Allione B, Cordonnier C, Heussel CP, Morrissey CO, Agrawal SG, Donnelly JP, Bresnik M, Hawkins MJ, Garner W, Gökbuget N. Randomized comparison of liposomal amphotericin B versus placebo to prevent invasive mycoses in acute lymphoblastic leukaemia. J Antimicrob Chemother 2018; 72:2359-2367. [PMID: 28575414 DOI: 10.1093/jac/dkx133] [Citation(s) in RCA: 57] [Impact Index Per Article: 9.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2016] [Accepted: 04/07/2017] [Indexed: 02/07/2023] Open
Abstract
Objectives To prevent invasive fungal disease (IFD) in adult patients undergoing remission-induction chemotherapy for newly diagnosed acute lymphoblastic leukaemia (ALL). Patients and methods In a double-blind multicentre Phase 3 study, patients received prophylactic liposomal amphotericin B (L-AMB) at 5 mg/kg intravenously or placebo twice weekly in a 2:1 random allocation during remission-induction treatment. The primary endpoint was the development of proven or probable IFD. Secondary endpoints included those focused on the safety and tolerability of prophylactic L-AMB. Results Three hundred and fifty-five patients from 86 centres in Europe and South America received at least one dose of L-AMB ( n = 237) or placebo ( n = 118). Rates of proven and probable IFD assessed independently were 7.9% (18/228) in the L-AMB group and 11.7% (13/111) in the placebo group ( P = 0.24). Rates of possible IFD were 4.8% (11/228) in the L-AMB and 5.4% (6/111) in the placebo group ( P = 0.82). The remission-induction phase was a median of 22 days for both groups. Overall mortality was similar between the groups: 7.2% (17/237) for L-AMB and 6.8% (8/118) for placebo ( P = 1.00). Hypokalaemia and creatinine increase were significantly more frequent with L-AMB. Conclusions The IFD rate among adult patients undergoing remission-induction chemotherapy for newly diagnosed ALL was 11.7% in the placebo group, and was not significantly different in patients receiving L-AMB, suggesting that the L-AMB regimen studied is not effective as prophylaxis against IFD. The IFD rate appears higher than previously reported, warranting further investigation. Tolerability of L-AMB was what might be expected. Further studies are needed to determine the optimal antifungal strategy during remission-induction chemotherapy of ALL.
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Affiliation(s)
- Oliver A Cornely
- Cologne Excellence Cluster on Cellular Stress Responses in Aging-Associated Diseases (CECAD), Department I of Internal Medicine, Clinical Trials Centre Cologne (ZKS), Center for Integrated Oncology (CIO KölnBonn), German Centre for Infection Research (DZIF), partner site Bonn-Cologne, University of Cologne, Cologne, Germany
| | - Thibaut Leguay
- Service d'hématologie clinique et Thérapie cellulaire, Hôpital du Haut-Lévèque, CHU de Bordeaux, France
| | - Johan Maertens
- KU Leuven-University of Leuven, Department of Microbiology and Immunology, University Hospitals Leuven, Department of Hematology, B-3000 Leuven, Belgium
| | | | | | - Carlo Castagnola
- Department of Hematology Oncology, Fondazione IRCCS Policlinico S. Matteo, Pavia, Italy
| | | | - Christina Rieger
- Medizinische Klinik und Poliklinik III, Klinikum der Universität München, Munich, Germany
| | - Mustafa Kondakci
- Klinik für Hämatologie, Onkologie und klin. Immunologie, Universitätsklinikum Düsseldorf, Düsseldorf, Germany
| | - Georg Härter
- Zentrum für Hormon- und Stoffwechselerkrankungen und Infektiologie, MVZ Endokrinologikum Ulm, and Department of Internal Medicine III, Ulm University Hospital Medical Center, Ulm, Germany
| | - Rafael F Duarte
- Department of Hematology, Hospital Universitario Puerta de Hierro Majadahonda, Madrid 28222, Spain
| | | | - Catherine Cordonnier
- AP-HP-Henri Mondor, Hematology Department and University Paris-Est Creteil, F-94010 Créteil, France
| | | | - C Orla Morrissey
- Department of Infectious Diseases, Alfred Health and Monash University, Melbourne, Australia
| | - Samir G Agrawal
- Division of Haemato-Oncology, St Bartholomew's Hospital, Barts Cancer Institute, Queen Mary University, London, UK
| | - J Peter Donnelly
- Department of Haematology, Radboud UMC, Nijmegen, the Netherlands
| | | | | | | | - Nicola Gökbuget
- Department of Medicine II, University Hospital, Goethe University, Frankfurt, Germany
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Polke M, Oelmann-Avendano J, Warth A, Heussel CP, Herth FJF, Eberhardt R. Successful treatment of a recurrent granulation polyp in the airways with high-dose-rate brachytherapy: a case report. J Med Case Rep 2017; 11:289. [PMID: 29047403 PMCID: PMC5648445 DOI: 10.1186/s13256-017-1465-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2017] [Accepted: 09/20/2017] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Benign central airway tumors are very rare diseases. Their unspecific symptoms are responsible for late diagnosis. Endoscopic interventions with different techniques and tools are widely used for their treatment. However, in certain cases interventional endoscopy might be unsuccessful and therefore other methods such as high-dose-rate brachytherapy could be a therapeutic option. CASE PRESENTATION A 76-year-old white German woman was referred to our clinic for an endoscopic treatment of a recurrent granulation polyp in her left main bronchus. She had dyspnea, coughing, and mucus retention. Three times resections via bronchoscopy were performed within less than a year. After each intervention the polyp regrew inside her left main bronchus causing a repeat of the initial symptoms. She presented to our clinic less than 1 month since the last intervention. Twice we performed a rigid bronchoscopy in total anesthesia where we resected the granulation polyp with a snare wire loop and did an argon plasma coagulation of its base. Due to the recurrent growing of the granuloma, we performed a high-dose-rate brachytherapy in conscious sedation after another interventional bronchoscopy with a resection of the polyp and argon plasma coagulation of the base. Three months after brachytherapy our patient came to our clinic for a follow-up with none of the initial symptoms. Only a small remnant of the polyp without a significant occlusion of her bronchus was visualized by bronchoscopy. Furthermore, 6 months after brachytherapy she was not presenting any of the initial symptoms. CONCLUSIONS This case report shows that high-dose-rate brachytherapy is a therapeutic option for the treatment of benign airway stenosis when other interventional treatments are not or are less than successful. However, further investigations are needed to prove the effectiveness and reliability of the method.
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Affiliation(s)
- M Polke
- Department of Pulmonology and Respiratory Care Medicine, Thoraxklinik at the University of Heidelberg, Röntgenstraße 1, 69126, Heidelberg, Germany.
| | - J Oelmann-Avendano
- Department of Radiation Oncology, Heidelberg University Hospital, Heidelberg, Germany
| | - A Warth
- Institute of Pathology, University of Heidelberg, Heidelberg, Germany.,Translational Lung Research Center Heidelberg, Member of the German Center for Lung Research, Heidelberg, Germany
| | - C P Heussel
- Diagnostic and Interventional Radiology with Nuclear Medicine, Thoraxklinik at the University of Heidelberg, Heidelberg, Germany.,Translational Lung Research Center Heidelberg, Member of the German Center for Lung Research, Heidelberg, Germany
| | - F J F Herth
- Department of Pulmonology and Respiratory Care Medicine, Thoraxklinik at the University of Heidelberg, Röntgenstraße 1, 69126, Heidelberg, Germany.,Translational Lung Research Center Heidelberg, Member of the German Center for Lung Research, Heidelberg, Germany
| | - R Eberhardt
- Department of Pulmonology and Respiratory Care Medicine, Thoraxklinik at the University of Heidelberg, Röntgenstraße 1, 69126, Heidelberg, Germany.,Translational Lung Research Center Heidelberg, Member of the German Center for Lung Research, Heidelberg, Germany
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Zhao J, Dinkel J, Warth A, Penzel R, Reinmuth N, Schnabel P, Muley T, Meister M, Zabeck H, Steins M, Yang JY, Zhou Q, Schlemmer HP, Herth FJF, Kauczor HU, Heussel CP. CT characteristics in pulmonary adenocarcinoma with epidermal growth factor receptor mutation. PLoS One 2017; 12:e0182741. [PMID: 28949965 PMCID: PMC5614426 DOI: 10.1371/journal.pone.0182741] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2016] [Accepted: 07/24/2017] [Indexed: 12/12/2022] Open
Abstract
Comprehensively investigate the association of CT morphology and clinical findings of adenocarcinoma with EGFR mutation status. Retrospectively included 282 patients who was pathologically proved as lung adenocarcinoma with known EGFR mutation status (mutations: 138 patients, female: 86, median age: 66 years; wildtype: 144 patients, female: 67, median age: 62 years) and their pre-treatment CT scans were analyzed. CT findings and clinical information were collected. Univariate and multivariable logistic regression analysis were performed. Adjusted for age, gender and smoking history of two groups, significantly more patients with pleural tags, pleural and liver metastases were found in the EGFR mutated group (P = 0.007, 0.004, and 0.043, respectively). Multivariable logistic regression analysis found that the model included age, gender, smoking history, air bronchogram, pleural tags, pleural and liver metastasis had a moderate predictive value for EGFR mutation status (AUC = 0.741, P < .0001). Exon-19 deletion was associated with air bronchogram which adjusted for age, gender and smoking history (P = 0.007, OR: 2.91, 95%CI: 1.25–7.79). The evidence of pleural tags, pleural and liver metastases go along with a higher probability of EGFR mutation in adenocarcinoma patients and air bronchogram is positively associated with Exon-19 deletion mutation.
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Affiliation(s)
- Jing Zhao
- Department of Diagnostic and Interventional Radiology, University Hospital of Heidelberg, Heidelberg, Germany
- Translational Lung Research Center Heidelberg (TLRC), Heidelberg, Germany
- Department of Diagnostic and Interventional Radiology, The First Affiliated Hospital of Sun Yat-Sen University, Guangzhou, Guangdong, China
- * E-mail: (Zhao J); (Yang J.Y)
| | - Julien Dinkel
- Department of Diagnostic and Interventional Radiology, University Hospital of Heidelberg, Heidelberg, Germany
- Translational Lung Research Center Heidelberg (TLRC), Heidelberg, Germany
| | - Arne Warth
- Translational Lung Research Center Heidelberg (TLRC), Heidelberg, Germany
- Institute of Pathology, University Hospital Heidelberg, Heidelberg, Germany
| | - Roland Penzel
- Institute of Pathology, University Hospital Heidelberg, Heidelberg, Germany
| | - Niels Reinmuth
- Airway Center North (ARCN), LungenClinic Grosshansdorf GmbH, Großhansdorf, Germany
| | - Philipp Schnabel
- Translational Lung Research Center Heidelberg (TLRC), Heidelberg, Germany
- Institute of Pathology, University Hospital Heidelberg, Heidelberg, Germany
| | - Thomas Muley
- Translational Lung Research Center Heidelberg (TLRC), Heidelberg, Germany
- Translational Research Unit, Thoraxklinik at University of Heidelberg, Heidelberg, Germany
| | - Michael Meister
- Translational Lung Research Center Heidelberg (TLRC), Heidelberg, Germany
- Translational Research Unit, Thoraxklinik at University of Heidelberg, Heidelberg, Germany
| | - Heike Zabeck
- Department of Thoracic Surgery, Thoraxklinik at University of Heidelberg, Heidelberg, Germany
| | - Martin Steins
- Translational Lung Research Center Heidelberg (TLRC), Heidelberg, Germany
- Department of Thoracic Oncology, Thoraxklinik at University of Heidelberg, Heidelberg, Germany
| | - Jian-yong Yang
- Department of Diagnostic and Interventional Radiology, The First Affiliated Hospital of Sun Yat-Sen University, Guangzhou, Guangdong, China
- * E-mail: (Zhao J); (Yang J.Y)
| | - Qian Zhou
- Clinical Trials Unit, The First Affiliated Hospital of Sun Yat-Sen University, Guangzhou, Guangdong, China
| | - Heinz-Peter Schlemmer
- Translational Lung Research Center Heidelberg (TLRC), Heidelberg, Germany
- Department of Radiology, German Cancer Research Center (dkfz), Heidelberg, Germany
| | - Felix J. F. Herth
- Translational Lung Research Center Heidelberg (TLRC), Heidelberg, Germany
- Department of Pneumology and Respiratory Critical Care Medicine, Thoraxklinik at University of Heidelberg, Heidelberg, Germany
| | - Hans-Ulrich Kauczor
- Department of Diagnostic and Interventional Radiology, University Hospital of Heidelberg, Heidelberg, Germany
- Translational Lung Research Center Heidelberg (TLRC), Heidelberg, Germany
| | - Claus Peter Heussel
- Department of Diagnostic and Interventional Radiology, University Hospital of Heidelberg, Heidelberg, Germany
- Translational Lung Research Center Heidelberg (TLRC), Heidelberg, Germany
- Department of Radiology, German Cancer Research Center (dkfz), Heidelberg, Germany
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Kauczor HU, Heussel CP, von Stackelberg O. Time to take CT screening to the next level? Eur Respir J 2017; 49:49/4/1700064. [PMID: 28424364 DOI: 10.1183/13993003.00064-2017] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2017] [Accepted: 01/19/2017] [Indexed: 12/18/2022]
Affiliation(s)
- Hans-Ulrich Kauczor
- Dept of Diagnostic and Interventional Radiology, University Medical Center Heidelberg, Heidelberg, Germany .,Translational Lung Research Center (TLRC) Heidelberg, Member of the German Center for Lung Research (DZL), Heidelberg, Germany.,Dept of Diagnostic and Interventional Radiology with Nuclear Medicine, Thoraxklinik, University Medical Center Heidelberg, Heidelberg, Germany
| | - Claus Peter Heussel
- Dept of Diagnostic and Interventional Radiology, University Medical Center Heidelberg, Heidelberg, Germany.,Translational Lung Research Center (TLRC) Heidelberg, Member of the German Center for Lung Research (DZL), Heidelberg, Germany.,Dept of Diagnostic and Interventional Radiology with Nuclear Medicine, Thoraxklinik, University Medical Center Heidelberg, Heidelberg, Germany
| | - Oyunbileg von Stackelberg
- Dept of Diagnostic and Interventional Radiology, University Medical Center Heidelberg, Heidelberg, Germany.,Translational Lung Research Center (TLRC) Heidelberg, Member of the German Center for Lung Research (DZL), Heidelberg, Germany.,Dept of Diagnostic and Interventional Radiology with Nuclear Medicine, Thoraxklinik, University Medical Center Heidelberg, Heidelberg, Germany
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Kontogianni K, Gerovasili V, Gompelmann D, Schuhmann M, Hoffmann H, Heussel CP, Herth FJ, Eberhardt R. Coil therapy for patients with severe emphysema and bilateral incomplete fissures - effectiveness and complications after 1-year follow-up: a single-center experience. Int J Chron Obstruct Pulmon Dis 2017; 12:383-394. [PMID: 28176954 PMCID: PMC5271380 DOI: 10.2147/copd.s117655] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
Background Lung volume reduction coil (LVRC) treatment is established in daily endoscopic lung volume reduction routine. The aim of this study was to evaluate the safety and efficacy of LVRC treatment. Patients and methods This was a retrospective analysis of 86 patients (male/female: 40/46, mean age: 64±7 years) with severe COPD and bilateral incomplete fissures. A total of 10 coils were unilaterally implanted in a single lobe, and 28 out of 86 patients were treated bilaterally. At 90-, 180-, and 365-day follow-up, changes in pulmonary function test (PFT), 6-minute walk test (6MWT) and modified Medical Research Council (mMRC) dyspnea scale, as well as possible complications, were recorded. Results At 90 days, the forced expiratory volume in 1 second did improve (P<0.001), but the improvement was not sustained at the 180- and 365-day follow-up (baseline: 0.71±0.21 vs 0.77±0.23 vs 0.73±0.22 vs 0.70±0.18 L). Both vital capacity and residual volume improved significantly (P<0.001) at the 90- and 180-day follow-up, but the improvement was lost after 365 days. Total lung capacity decreased at the 90-day follow-up but returned to baseline values at the 180- and 365-day follow-up. 6MWT (P=0.01) and mMRC (P=0.007) also improved at 90 and 180 days (Δ6MWT of 31±54 and 20±60 m, respectively), but the improvement was also lost at the 365-day follow-up. No significant further improvement was evident at any point in the follow-up after the second procedure. A total of 4 out of 86 patients passed away due to complications. Significant complications in the first 3 months and then at 12 months included the following: severe hemoptysis in 4 (3.5%) and 4 (3.5%) patients, pneumonia requiring hospitalization in 32 (28.1%) and 9 (7.9%) patients and pneumothorax in 7 (6.1%) and 2 (1.7%) patients, respectively. Milder adverse events included self-limited hemoptysis, pneumonias, or COPD exacerbations treated orally. Conclusion LVRC improved PFT, 6MWT and mMRC initially, but the improvement was lost after 365 days. Furthermore, we observed 4 deaths and significant severe complications, which need to be further elucidated.
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Affiliation(s)
- Konstantina Kontogianni
- Department of Pulmonology and Respiratory Care Medicine, Thoraxklinik at the University of Heidelberg; Translational Lung Research Center Heidelberg, Member of the German Center for Lung Research DZL, Heidelberg, Germany
| | - Vasiliki Gerovasili
- Department of Respiratory Medicine, Harefield Hospital, Royal Brompton & Harefield NHS Foundation Trust, London, UK
| | - Daniela Gompelmann
- Department of Pulmonology and Respiratory Care Medicine, Thoraxklinik at the University of Heidelberg; Translational Lung Research Center Heidelberg, Member of the German Center for Lung Research DZL, Heidelberg, Germany
| | - Maren Schuhmann
- Department of Pulmonology and Respiratory Care Medicine, Thoraxklinik at the University of Heidelberg; Translational Lung Research Center Heidelberg, Member of the German Center for Lung Research DZL, Heidelberg, Germany
| | - Hans Hoffmann
- Translational Lung Research Center Heidelberg, Member of the German Center for Lung Research DZL, Heidelberg, Germany; Department of Thoracic Surgery, Thoraxklinik at the University of Heidelberg
| | - Claus Peter Heussel
- Translational Lung Research Center Heidelberg, Member of the German Center for Lung Research DZL, Heidelberg, Germany; Diagnostic and Interventional Radiology with Nuclear Medicine, Thoraxklinik at the University of Heidelberg, Heidelberg, Germany
| | - Felix Jf Herth
- Department of Pulmonology and Respiratory Care Medicine, Thoraxklinik at the University of Heidelberg; Translational Lung Research Center Heidelberg, Member of the German Center for Lung Research DZL, Heidelberg, Germany
| | - Ralf Eberhardt
- Department of Pulmonology and Respiratory Care Medicine, Thoraxklinik at the University of Heidelberg; Translational Lung Research Center Heidelberg, Member of the German Center for Lung Research DZL, Heidelberg, Germany
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Nattenmüller J, Wochner R, Muley T, Steins M, Hummler S, Teucher B, Wiskemann J, Kauczor HU, Wielpütz MO, Heussel CP. Prognostic Impact of CT-Quantified Muscle and Fat Distribution before and after First-Line-Chemotherapy in Lung Cancer Patients. PLoS One 2017; 12:e0169136. [PMID: 28107410 PMCID: PMC5249228 DOI: 10.1371/journal.pone.0169136] [Citation(s) in RCA: 77] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/03/2016] [Accepted: 12/12/2016] [Indexed: 02/07/2023] Open
Abstract
Introduction Cachexia and sarcopenia are associated with poor outcome and increased chemotherapy-induced toxicity in lung cancer patients. However, the complex interplay of obesity, sarcopenia and cachexia, and its impact on survival in the context of first-line-chemotherapy is not yet understood. Methods In 200 consecutively recruited lung cancer patients (70 female, mean age 62y; mean BMI 25 kg/m2; median follow-up 15.97 months) with routine staging-CT before and after chemotherapy (CTX, mean interval: 4.3 months), densitometric quantification of total (TFA), visceral (VFA), and subcutaneous-fat-area (SFA), inter-muscular-fat-area (IMFA), muscle-density (MD), muscle-area (MA) and skeletal-muscle-index (SMI) was performed retrospectively to evaluate changes under chemotherapy and the impact on survival. Results We observed increases in TFA, VFA, SFA, VFA/SFA, and IMFA (p<0.05–0.001), while there were decreases in MA, MD and BMI (p<0.05–0.001) after chemotherapy. High pre-therapeutic VFA/SFA was a predictive factor for poor survival (HR = 1.272; p = 0.008), high pre-therapeutic MD for improved survival (HR = 0.93; p<0.05). Decrease in BMI (HR = 1.303; p<0.001), weight (HR = 1.067; p<0.001) and SMI (HR = 1.063; p<0.001) after chemotherapy were associated with poor survival. Patients with ≥4 CTX-cycles showed increased survival (17.6 vs. 9.1months), less muscle depletion (SMIdifference: p<0.05) and no BMI loss (BMIdifference: p<0.001). Conclusions After chemotherapy, patients exhibited sarcopenia with decreased muscle and increased adipose tissue compartments, which was not adequately mirrored by BMI and weight loss but by imaging. Particularly sarcopenic patients received less CTX-cycles and had poorer survival. As loss of BMI, weight and muscle were associated with poor survival, early detection (via imaging) and prevention (via physical exercise and nutrition) of sarcopenia may potentially improve outcome and reduce chemotherapy-induced toxicity.
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Affiliation(s)
- Johanna Nattenmüller
- Department of Diagnostic and Interventional Radiology, University Hospital, Im Neuenheimer Feld, Heidelberg, Germany
- Translational Lung Research Center Heidelberg (TLRC), Member of the German Center for Lung Research (DZL), Im Neuenheimer Feld, Heidelberg, Germany
- Department of Diagnostic and Interventional Radiology with Nuclear Medicine, Thoraxklinik at University of Heidelberg, Amalienstraße, Heidelberg, Germany
- * E-mail:
| | - Raoul Wochner
- Translational Lung Research Center Heidelberg (TLRC), Member of the German Center for Lung Research (DZL), Im Neuenheimer Feld, Heidelberg, Germany
- Department of Diagnostic and Interventional Radiology with Nuclear Medicine, Thoraxklinik at University of Heidelberg, Amalienstraße, Heidelberg, Germany
| | - Thomas Muley
- Translational Lung Research Center Heidelberg (TLRC), Member of the German Center for Lung Research (DZL), Im Neuenheimer Feld, Heidelberg, Germany
- Translational Research Unit (STF), Thoraxklinik at University of Heidelberg, Amalienstraße, Heidelberg, Germany
| | - Martin Steins
- Translational Lung Research Center Heidelberg (TLRC), Member of the German Center for Lung Research (DZL), Im Neuenheimer Feld, Heidelberg, Germany
- Department of Thoracic Oncology, Thoraxklinik at University of Heidelberg, Amalienstraße, Heidelberg, Germany
| | - Simone Hummler
- Translational Lung Research Center Heidelberg (TLRC), Member of the German Center for Lung Research (DZL), Im Neuenheimer Feld, Heidelberg, Germany
- Department of Thoracic Oncology, Thoraxklinik at University of Heidelberg, Amalienstraße, Heidelberg, Germany
- Department of Pneumology and Respiratory Critical Care Medicine, Thoraxklinik at University of Heidelberg, Amalienstraße, Heidelberg, German
| | - Birgit Teucher
- Translational Lung Research Center Heidelberg (TLRC), Member of the German Center for Lung Research (DZL), Im Neuenheimer Feld, Heidelberg, Germany
| | - Joachim Wiskemann
- Division of Medical Oncology, National Center for Tumor Diseases (NCT); Heidelberg University Hospital, Im Neuenheimer Feld, Heidelberg, Germany
| | - Hans-Ulrich Kauczor
- Department of Diagnostic and Interventional Radiology, University Hospital, Im Neuenheimer Feld, Heidelberg, Germany
- Translational Lung Research Center Heidelberg (TLRC), Member of the German Center for Lung Research (DZL), Im Neuenheimer Feld, Heidelberg, Germany
- Department of Diagnostic and Interventional Radiology with Nuclear Medicine, Thoraxklinik at University of Heidelberg, Amalienstraße, Heidelberg, Germany
| | - Mark Oliver Wielpütz
- Department of Diagnostic and Interventional Radiology, University Hospital, Im Neuenheimer Feld, Heidelberg, Germany
- Translational Lung Research Center Heidelberg (TLRC), Member of the German Center for Lung Research (DZL), Im Neuenheimer Feld, Heidelberg, Germany
- Department of Diagnostic and Interventional Radiology with Nuclear Medicine, Thoraxklinik at University of Heidelberg, Amalienstraße, Heidelberg, Germany
| | - Claus Peter Heussel
- Department of Diagnostic and Interventional Radiology, University Hospital, Im Neuenheimer Feld, Heidelberg, Germany
- Translational Lung Research Center Heidelberg (TLRC), Member of the German Center for Lung Research (DZL), Im Neuenheimer Feld, Heidelberg, Germany
- Department of Diagnostic and Interventional Radiology with Nuclear Medicine, Thoraxklinik at University of Heidelberg, Amalienstraße, Heidelberg, Germany
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Vehreschild JJ, Heussel CP, Groll AH, Vehreschild MJGT, Silling G, Würthwein G, Brecht M, Cornely OA. Serial assessment of pulmonary lesion volume by computed tomography allows survival prediction in invasive pulmonary aspergillosis. Eur Radiol 2017; 27:3275-3282. [PMID: 28083695 DOI: 10.1007/s00330-016-4717-4] [Citation(s) in RCA: 28] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2016] [Revised: 12/01/2016] [Accepted: 12/16/2016] [Indexed: 11/26/2022]
Abstract
BACKGROUND Serial chest CT is the standard of care to establish treatment success in invasive pulmonary aspergillosis (IPA). Data are lacking how response should be defined. METHODS Digital CT images from a clinical trial on treatment of IPA were re-evaluated and compared with available biomarkers. Total volume of pneumonia was added up after manual measurement of each lesion, followed by statistical analysis. RESULTS One-hundred and ninety CT scans and 309 follow-up datasets from 40 patients were available for analysis. Thirty-one were neutropenic. Baseline galactomannan (OR 4.06, 95%CI: 1.08-15.31) and lesion volume (OR 3.14, 95%CI: 0.73-13.52) were predictive of death. Lesion volume at d7 and trend between d7 and d14 were strong predictors of death (OR 20.01, 95%CI: 1.42-282.00 and OR 15.97, 95%CI: 1.62-157.32) and treatment being rated as unsuccessful (OR 4.75, 95%CI: 0.94-24.05 and OR 40.69, 95%CI: 2.55-649.03), which was confirmed by a Cox proportional hazards model using time-dependent covariates. CONCLUSION Any increase in CT lesion volume between day 7 and day 14 was a sensitive marker of a lethal outcome (>50%), supporting a CT rescan each one and 2 weeks after initial detection of IPA. The predictive value exceeded all other biomarkers. Further CT follow-up after response at day 14 was of low additional value. KEY POINTS • CT evaluation offers good prediction of outcome for invasive pulmonary aspergillosis. • Predictive capability exceeds galactomannan, blood counts, and lesion count. • Any progression between day 7 and day 14 constitutes a high-risk scenario.
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Affiliation(s)
- J J Vehreschild
- Department I of Internal Medicine, University Hospital of Cologne, Kerpener Str. 62, 50937, Cologne, Germany.
- German Centre for Infection Research, Partner Site Bonn-Cologne, Cologne, Germany.
| | - C P Heussel
- Diagnostic and Interventional Radiology with Nuclear Medicine, Chest Clinic at University Hospital Heidelberg, Heidelberg, Germany
- Department of Diagnostic and Interventional Radiology, University Hospital of Heidelberg, Im Neuenheimer Feld 110, 69120, Heidelberg, Germany
- Translational Lung Research Center Heidelberg (TLRC), Member of the German Center for Lung Research (DZL), Im Neuenheimer Feld 430, 69120, Heidelberg, Germany
| | - A H Groll
- Infectious Disease Research Program, Department of Paediatric Haematology/Oncology, University Children's Hospital, Muenster, Germany
| | - M J G T Vehreschild
- Department I of Internal Medicine, University Hospital of Cologne, Kerpener Str. 62, 50937, Cologne, Germany
- German Centre for Infection Research, Partner Site Bonn-Cologne, Cologne, Germany
| | - G Silling
- Department of Medicine A, Haematology/Oncology, University of Muenster, Muenster, Germany
| | - G Würthwein
- Centre for Clinical Trials, ZKS Muenster (BMBF 01KN1105), University Hospital Muenster, Muenster, Germany
| | - M Brecht
- Diagnostic and Interventional Radiology with Nuclear Medicine, Chest Clinic at University Hospital Heidelberg, Heidelberg, Germany
| | - O A Cornely
- Department I of Internal Medicine, University Hospital of Cologne, Kerpener Str. 62, 50937, Cologne, Germany
- Clinical Trials Center Cologne, ZKS Koeln (BMBF 01KN1106), University of Cologne, Cologne, Germany
- Center for Integrated Oncology CIO KölnBonn, Cologne, Germany
- Cologne Excellence Cluster on Cellular Stress Responses in Aging-Associated Diseases (CECAD), University of Cologne, Cologne, Germany
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