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Fatania K, Brown PJ, Xie C, McDermott G, Callister MEJ, Graham R, Subesinghe M, Gleeson FV, Scarsbrook AF. Multi-observer concordance and accuracy of the British Thoracic Society scale and other visual assessment qualitative criteria for solid pulmonary nodule assessment using FDG PET-CT. Clin Radiol 2020; 75:878.e21-878.e28. [PMID: 32709393 DOI: 10.1016/j.crad.2020.06.028] [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] [Received: 01/20/2020] [Accepted: 06/24/2020] [Indexed: 10/23/2022]
Abstract
AIM To compare the interobserver reliability and diagnostic accuracy of the British Thoracic Society (BTS) scale and other visual assessment criteria in the context of 2-[18F]-fluoro-2-deoxy-d-glucose (FDG) positron-emission tomography (PET)-computed tomography (CT) evaluation of solid pulmonary nodules (SPNs). MATERIALS AND METHODS Fifty patients who underwent FDG PET-CT for assessment of a SPN were identified. Seven reporters with varied experience at four centres graded FDG uptake visually using the British Thoracic Society (BTS) four-point scale. Five reporters also scored SPNs according to three- and five-point visual assessment scales and using semi-quantitative assessment (maximum standardised uptake value [SUVmax]). Interobserver reliability was assessed with the intra-class correlation coefficient (ICC) and weighted Cohen's kappa (κ). Diagnostic performance was evaluated by receiver operator characteristic (ROC) analysis. RESULTS Good interobserver reliability was demonstrated with the BTS scale (ICC=0.78, 95% confidence interval [CI]: 0.69-0.85) and five-point scale (ICC=0.78, 95 CI 0.68-0.86), whilst the three-point scale demonstrated moderate reliability (ICC=0.70, 95% CI: 0.59-0.80). Almost perfect agreement was achieved between two consultants (κ=0.85), and substantial agreement between two other consultants (κ=0.78) using the BTS scale. ROC curves for the BTS and five-point scales demonstrated equivalent accuracy (BTS area under the ROC curve [AUC]=0.768; five-point AUC=0.768). SUVmax was no more accurate compared to the BTS scale (SUVmax AUC=0.794; BTS AUC=0.768, p=0.43). CONCLUSIONS The BTS scale can be applied reliably by reporters with varied levels of PET-CT reporting experience, across different centres and has a diagnostic performance that is not surpassed by alternative scales.
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Affiliation(s)
- K Fatania
- Department of Radiology, Leeds Teaching Hospitals NHS Trust, Leeds, UK.
| | - P J Brown
- Department of Radiology, Leeds Teaching Hospitals NHS Trust, Leeds, UK
| | - C Xie
- Department of Radiology, Oxford University Hospitals Foundation Trust, Oxford, UK
| | - G McDermott
- Department of Medical Physics, Leeds Teaching Hospitals NHS Trust, Leeds, UK
| | - M E J Callister
- Department of Respiratory Medicine, Leeds Teaching Hospitals NHS Trust, Leeds, UK
| | - R Graham
- Department of Radiology, Royal United Hospitals Bath NHS Foundation Trust, Bath, UK
| | - M Subesinghe
- King's College London & Guy's and St. Thomas' PET Centre, St Thomas' Hospital, London, UK; Department of Cancer Imaging, School of Biomedical Engineering and Imaging Sciences, King's College London, London, UK
| | - F V Gleeson
- Department of Radiology, Oxford University Hospitals Foundation Trust, Oxford, UK
| | - A F Scarsbrook
- Department of Radiology, Leeds Teaching Hospitals NHS Trust, Leeds, UK; Leeds Institute of Research at St James', University of Leeds, UK
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Horst C, Callister MEJ, Janes SM. Low-dose Computed Tomography Screening: The (Other) Lung Cancer Revolution. Clin Oncol (R Coll Radiol) 2019; 31:697-701. [PMID: 31471179 DOI: 10.1016/j.clon.2019.07.022] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2019] [Revised: 07/26/2019] [Accepted: 07/30/2019] [Indexed: 11/19/2022]
Affiliation(s)
- C Horst
- Lungs for Living, UCL Respiratory, University College London, London, UK.
| | - M E J Callister
- Department of Respiratory Medicine, Leeds Teaching Hospitals NHS Trust, St James's University Hospital, Leeds, UK
| | - S M Janes
- Lungs for Living, UCL Respiratory, University College London, London, UK
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Kennedy MPT, Lummis KL, Spencer K, Franks K, Snee M, Callister MEJ. S64 Rates and sites of recurrence following radical treatment of stage I lung cancer. Thorax 2016. [DOI: 10.1136/thoraxjnl-2016-209333.70] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
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Kennedy MPT, Walkowiak O, Callister MEJ. P166 The frequency of chest radiographs prior to the onset of lung cancer symptoms. Thorax 2015. [DOI: 10.1136/thoraxjnl-2015-207770.303] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
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Kennedy MPT, Hall PS, Callister MEJ. S73 Healthcare costs associated with lung cancer diagnosed at emergency hospitalisation. Thorax 2015. [DOI: 10.1136/thoraxjnl-2015-207770.79] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
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Kennedy MPT, Quinn JA, Biswas AR, Rothwell A, Scally A, Cheyne L, Callister MEJ. S104 Factors affecting sensitising EGFR mutation rate and cell type in stage IIIB/IV lung cancer: Abstract S104 Table 1. Thorax 2015. [DOI: 10.1136/thoraxjnl-2015-207770.110] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
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Callister MEJ, Baldwin DR, Akram AR, Barnard S, Cane P, Draffan J, Franks K, Gleeson F, Graham R, Malhotra P, Prokop M, Rodger K, Subesinghe M, Waller D, Woolhouse I. British Thoracic Society guidelines for the investigation and management of pulmonary nodules. Thorax 2015; 70 Suppl 2:ii1-ii54. [PMID: 26082159 DOI: 10.1136/thoraxjnl-2015-207168] [Citation(s) in RCA: 534] [Impact Index Per Article: 59.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Affiliation(s)
- M E J Callister
- Department of Respiratory Medicine, Leeds Teaching Hospitals, Leeds, UK
| | - D R Baldwin
- Nottingham University Hospitals, Nottingham, UK
| | - A R Akram
- Royal Infirmary of Edinburgh, Edinburgh, UK
| | - S Barnard
- Department of Cardiothoracic Surgery, Freeman Hospital, Newcastle, UK
| | - P Cane
- Department of Histopathology, St Thomas' Hospital, London, UK
| | - J Draffan
- University Hospital of North Tees, Stockton on Tees, UK
| | - K Franks
- Clinical Oncology, St James's Institute of Oncology, Leeds, UK
| | - F Gleeson
- Department of Radiology, Oxford University Hospitals NHS Trust, Oxford, UK
| | | | - P Malhotra
- St Helens and Knowsley Teaching Hospitals NHS Trust, UK
| | - M Prokop
- Department of Radiology and Nuclear Medicine, Radboud University Medical Center, Nijmegen, Netherlands
| | - K Rodger
- Respiratory Medicine, St James's University Hospital, Leeds, UK
| | - M Subesinghe
- Department of Radiology, Churchill Hospital, Oxford, UK
| | - D Waller
- Department of Thoracic Surgery, Glenfield Hospital, Leicester, UK
| | - I Woolhouse
- Department of Respiratory Medicine, University Hospitals of Birmingham, Birmingham, UK
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Cheyne L, Esterbrook G, Viadyanathan S, Milton R, Smith G, Blaxill P, Clarke K, Snee M, Franks K, Callister MEJ. S109 The introduction of stereotactic ablative radiotherapy increases overall radical treatment rates for stage I lung cancer but does not reduce surgical resection rates–a two centre study. Thorax 2013. [DOI: 10.1136/thoraxjnl-2013-204457.116] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
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Cheyne L, Taylor A, Milton R, Fear J, Callister MEJ. Social deprivation does not affect lung cancer stage at presentation or disease outcome. Lung Cancer 2013; 81:247-51. [PMID: 23570796 DOI: 10.1016/j.lungcan.2013.03.012] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.0] [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: 11/22/2012] [Revised: 03/04/2013] [Accepted: 03/11/2013] [Indexed: 11/26/2022]
Abstract
INTRODUCTION Lung cancer mortality rates are higher in more deprived populations. This may simply reflect higher incidence of the disease, or additionally delayed presentation and worse outcomes amongst more deprived patients. Low socio-economic status (SES) has also been linked to cancer fatalism which might account for such differences. We determined the interaction between SES, patient's characteristics at presentation with lung cancer, and disease outcome at a large UK teaching hospital. METHODS Stage, PS at presentation, treatment and survival data, index of multiple deprivation score and ACORN group (geo-demographic segmentation tool) were analysed for 1432 patients. RESULTS There were no significant differences in stage or PS distribution by IMD quintile or ACORN group. When patients with stage I/II disease were considered, there were no differences in IMD or ACORN group for those undergoing or not undergoing surgical resection. Similarly when the whole cohort was considered, there were no differences in these parameters between those receiving and not receiving any anti-cancer therapy. There was a non-significant trend to lower IMD score (i.e. less deprivation) in the stage IIIb/IV patients receiving palliative chemotherapy compared to those not receiving chemotherapy. There was no significant difference in median survival or one-year survival according to IMD quintile or ACORN group. CONCLUSION In our patient cohort, deprivation does not appear to affect stage or performance status at presentation, nor survival from lung cancer. If cancer fatalism is more prevalent in deprived populations, this does not appear to lead to later diagnosis nor worse disease outcome.
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Affiliation(s)
- L Cheyne
- Leeds Teaching Hospitals NHS Trust, United Kingdom.
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Cheyne L, Milton R, Fear J, Callister MEJ. P63 Variability in GP Referral Rates For Chest X-Ray Does Not Appear to Affect Stage or Performance Status of Patients Diagnosed with Lung Cancer. Thorax 2012. [DOI: 10.1136/thoraxjnl-2012-202678.204] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
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Robson JM, Vaidyanathan S, Callister MEJ. S94 Stereotactic Radiotherapy for Stage 1 Non Small Cell Lung Cancer: How much occult nodal disease are we missing? Thorax 2012. [DOI: 10.1136/thoraxjnl-2012-202678.100] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
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Cheyne L, Foster C, Lovatt V, Hewitt F, Cresswell L, Fullard B, Fear J, Darby M, Robertson R, Plant PK, Milton R, Callister MEJ. S91 Improved Lung Cancer Survival and Reduced Emergency Diagnoses Resulting from an Early Diagnosis Campaign in Leeds 2011. Thorax 2012. [DOI: 10.1136/thoraxjnl-2012-202678.097] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
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Dwarakanath A, Callister MEJ. P159 Rate of chest x-rays (CXR) twelve months prior diagnosis of lung cancer. Thorax 2011. [DOI: 10.1136/thoraxjnl-2011-201054c.159] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
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Malhotra P, Lovell N, Plant PK, Callister MEJ, Karthik S, Scarsbrook A. P162 Comparison of clinical characteristics and outcomes of patients with PET positive vs PET negative solitary pulmonary nodules managed by a Lung MDT. Thorax 2011. [DOI: 10.1136/thoraxjnl-2011-201054c.162] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
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Callister MEJ, Gill A, Allott W, Plant PK. Endobronchial ultrasound guided transbronchial needle aspiration of mediastinal lymph nodes for lung cancer staging: a projected cost analysis. Thorax 2008; 63:384. [DOI: 10.1136/thx.2007.090308] [Citation(s) in RCA: 26] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
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Sato H, Callister MEJ, Mumby S, Quinlan GJ, Welsh KI, duBois RM, Evans TW. KL-6 levels are elevated in plasma from patients with acute respiratory distress syndrome. Eur Respir J 2004; 23:142-5. [PMID: 14738246 DOI: 10.1183/09031936.03.00070303] [Citation(s) in RCA: 78] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
The acute respiratory distress syndrome (ARDS) is an extreme form of lung injury characterised by disruption to the alveolar epithelium. KL-6 is a mucin-like glycoprotein expressed on type II pneumocytes. Circulating levels of KL-6 have diagnostic and prognostic significance in a number of interstitial lung diseases, and when elevated are thought to indicate disruption of the alveolar epithelial lining. In this study, the authors sought to determine whether plasma KL-6 levels were elevated in patients with ARDS and whether these were associated with aetiology, disease severity, outcome or ventilatory strategy. Plasma samples were collected from 28 patients with ARDS, nine ventilated controls of matched illness severity and 10 healthy individuals. KL-6 concentrations were measured by enzyme-linked immunosorbent assay. Patients with ARDS had higher plasma levels of KL-6 (median 537 U x mL(-1), interquartile range (IQR) 383-1,119), as compared to ventilated controls (median 255 U x mL(-1), IQR 83-338) and normal individuals (median 215 U x mL(-1), IQR 149-307). In patients with ARDS, plasma KL-6 levels were higher in nonsurvivors than survivors, and correlated positively with oxygenation index and negatively with arterial oxygen tension:inspiratory oxygen fraction ratio. There were also significant positive correlations with mean and peak airway pressures. Elevated levels of plasma KL-6 may provide a useful marker for acute respiratory distress syndrome in ventilated patients and have possible prognostic significance. Alveolar epithelial cell damage may be influenced by the nature of mechanical ventilatory support.
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Affiliation(s)
- H Sato
- Interstitial Lung Disease Unit, National Heart and Lung Institute, Imperial College, Royal Brompton Hospital, London, SW3 6NP, UK
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Callister MEJ, Barringer J, Thanabalasingam ST, Gair R, Davidson RN. Pulmonary tuberculosis among political asylum seekers screened at Heathrow Airport, London, 1995-9. Thorax 2002; 57:152-6. [PMID: 11828046 PMCID: PMC1746236 DOI: 10.1136/thorax.57.2.152] [Citation(s) in RCA: 42] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
BACKGROUND Over 50% of cases of tuberculosis (TB) in the UK occur in people born overseas, and new entrants to the country are screened for TB. A study was undertaken to determine the prevalence and disease characteristics of pulmonary TB in new entrants to the UK seeking political asylum. METHODS A retrospective analysis of the results of screening 53 911 political asylum seekers arriving at Heathrow Airport between 1995 and 1999 was performed by studying Airport Health Control Unit records and hospital medical records. Outcome measures were chest radiograph abnormalities, sputum smear, culture, and drug resistance data for Mycobacterium tuberculosis. RESULTS The overall prevalence of active TB in political asylum seekers was 241 per 100 000. There were large variations in prevalences of TB between asylum seekers from different regions, with low rates from the Middle East and high rates from the Indian subcontinent and sub-Saharan Africa. The frequency of drug resistance was high; 22.6% of culture positive cases were isoniazid resistant, 7.5% were multidrug resistant (resistant to both isoniazid and rifampicin), and 4% of cases diagnosed with active disease had multidrug resistant TB. CONCLUSIONS The prevalence rate of TB in political asylum seekers entering the UK through Heathrow Airport is high and more M tuberculosis isolates from asylum seekers are drug resistant than in the UK population. Extrapolating these figures, it is estimated that 101 political asylum seekers with active pulmonary TB enter the UK every year, of whom about 25 would have smear positive disease.
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Affiliation(s)
- M E J Callister
- Department of Infection and Tropical Medicine, Lister Unit, Northwick Park Hospital, Harrow, Middlesex HA1 3UJ, UK
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