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Pereira LFF, dos Santos RS, Bonomi DO, Franceschini J, Santoro IL, Miotto A, de Sousa TLF, Chate RC, Hochhegger B, Gomes A, Schneider A, de Araújo CA, Escuissato DL, Prado GF, Costa-Silva L, Zamboni MM, Ghefter MC, Corrêa PCRP, Torres PPTES, Mussi RK, Muglia VF, de Godoy I, Bernardo WM. Lung cancer screening in Brazil: recommendations from the Brazilian Society of Thoracic Surgery, Brazilian Thoracic Association, and Brazilian College of Radiology and Diagnostic Imaging. J Bras Pneumol 2024; 50:e20230233. [PMID: 38536982 PMCID: PMC11095927 DOI: 10.36416/1806-3756/e20230233] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2023] [Accepted: 12/13/2023] [Indexed: 05/18/2024] Open
Abstract
Although lung cancer (LC) is one of the most common and lethal tumors, only 15% of patients are diagnosed at an early stage. Smoking is still responsible for more than 85% of cases. Lung cancer screening (LCS) with low-dose CT (LDCT) reduces LC-related mortality by 20%, and that reduction reaches 38% when LCS by LDCT is combined with smoking cessation. In the last decade, a number of countries have adopted population-based LCS as a public health recommendation. Albeit still incipient, discussion on this topic in Brazil is becoming increasingly broad and necessary. With the aim of increasing knowledge and stimulating debate on LCS, the Brazilian Society of Thoracic Surgery, the Brazilian Thoracic Association, and the Brazilian College of Radiology and Diagnostic Imaging convened a panel of experts to prepare recommendations for LCS in Brazil. The recommendations presented here were based on a narrative review of the literature, with an emphasis on large population-based studies, systematic reviews, and the recommendations of international guidelines, and were developed after extensive discussion by the panel of experts. The following topics were reviewed: reasons for screening; general considerations about smoking; epidemiology of LC; eligibility criteria; incidental findings; granulomatous lesions; probabilistic models; minimum requirements for LDCT; volumetric acquisition; risks of screening; minimum structure and role of the multidisciplinary team; practice according to the Lung CT Screening Reporting and Data System; costs versus benefits of screening; and future perspectives for LCS.
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Affiliation(s)
- Luiz Fernando Ferreira Pereira
- . Serviço de Pneumologia, Hospital das Clínicas, Faculdade de Medicina, Universidade Federal de Minas Gerais - UFMG - Belo Horizonte (MG) Brasil
| | - Ricardo Sales dos Santos
- . Serviço de Cirurgia Torácica, Hospital Israelita Albert Einstein, São Paulo (SP) Brasil
- . Programa ProPulmão, SENAI CIMATEC e SDS Healthline, Salvador (BA) Brasil
| | - Daniel Oliveira Bonomi
- . Departamento de Cirurgia Torácica, Faculdade de Medicina, Universidade Federal de Minas Gerais - UFMG - Belo Horizonte (MG) Brasil
| | - Juliana Franceschini
- . Programa ProPulmão, SENAI CIMATEC e SDS Healthline, Salvador (BA) Brasil
- . Fundação ProAR, Salvador (BA) Brasil
| | - Ilka Lopes Santoro
- . Disciplina de Pneumologia, Departamento de Medicina, Escola Paulista de Medicina, Universidade Federal de São Paulo - UNIFESP - São Paulo (SP) Brasil
| | - André Miotto
- . Disciplina de Cirurgia Torácica, Departamento de Cirurgia, Escola Paulista de Medicina, Universidade Federal de São Paulo - UNIFESP - São Paulo (SP) Brasil
| | - Thiago Lins Fagundes de Sousa
- . Serviço de Pneumologia, Hospital Universitário Alcides Carneiro, Universidade Federal de Campina Grande - UFCG - Campina Grande (PB) Brasil
| | - Rodrigo Caruso Chate
- . Serviço de Radiologia, Hospital Israelita Albert Einstein, São Paulo (SP) Brasil
| | - Bruno Hochhegger
- . Department of Radiology, University of Florida, Gainesville (FL) USA
| | - Artur Gomes
- . Serviço de Cirurgia Torácica, Santa Casa de Misericórdia de Maceió, Maceió (AL) Brasil
| | - Airton Schneider
- . Serviço de Cirurgia Torácica, Hospital São Lucas, Escola de Medicina, Pontifícia Universidade Católica do Rio Grande do Sul - PUCRS - Porto Alegre (RS) Brasil
| | - César Augusto de Araújo
- . Programa ProPulmão, SENAI CIMATEC e SDS Healthline, Salvador (BA) Brasil
- . Departamento de Radiologia, Faculdade de Medicina da Bahia - UFBA - Salvador (BA) Brasil
| | - Dante Luiz Escuissato
- . Departamento de Clínica Médica, Universidade Federal Do Paraná - UFPR - Curitiba (PR) Brasil
| | | | - Luciana Costa-Silva
- . Serviço de Diagnóstico por Imagem, Instituto Hermes Pardini, Belo Horizonte (MG) Brasil
| | - Mauro Musa Zamboni
- . Instituto Nacional de Câncer José Alencar Gomes da Silva, Rio de Janeiro (RJ) Brasil
- . Centro Universitário Arthur Sá Earp Neto/Faculdade de Medicina de Petrópolis -UNIFASE - Petrópolis (RJ) Brasil
| | - Mario Claudio Ghefter
- . Serviço de Cirurgia Torácica, Hospital Israelita Albert Einstein, São Paulo (SP) Brasil
- . Serviço de Cirurgia Torácica, Hospital do Servidor Público Estadual, São Paulo (SP) Brasil
| | | | | | - Ricardo Kalaf Mussi
- . Serviço de Cirurgia Torácica, Hospital das Clínicas, Universidade Estadual de Campinas - UNICAMP - Campinas (SP) Brasil
| | - Valdair Francisco Muglia
- . Departamento de Imagens Médicas, Oncologia e Hematologia, Faculdade de Medicina de Ribeirão Preto, Universidade de São Paulo - USP - Ribeirão Preto (SP) Brasil
| | - Irma de Godoy
- . Disciplina de Pneumologia, Departamento de Clínica Médica, Faculdade de Medicina de Botucatu, Universidade Estadual Paulista, Botucatu (SP) Brasil
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Zanardo AP, Brentano VB, Grando RD, Rambo RR, Hertz FT, Anflor LC, dos Santos JFP, Galvão GS, Andrade CF. Detection of subsolid nodules on chest CT scans during the COVID-19 pandemic. J Bras Pneumol 2024; 49:e20230300. [PMID: 38232254 PMCID: PMC10769470 DOI: 10.36416/1806-3756/e20230300] [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] [Received: 09/15/2023] [Accepted: 10/09/2023] [Indexed: 01/19/2024] Open
Abstract
OBJECTIVE To investigate the detection of subsolid nodules (SSNs) on chest CT scans of outpatients before and during the COVID-19 pandemic, as well as to correlate the imaging findings with epidemiological data. We hypothesized that (pre)malignant nonsolid nodules were underdiagnosed during the COVID-19 pandemic because of an overlap of imaging findings between SSNs and COVID-19 pneumonia. METHODS This was a retrospective study including all chest CT scans performed in adult outpatients (> 18 years of age) in September of 2019 (i.e., before the COVID-19 pandemic) and in September of 2020 (i.e., during the COVID-19 pandemic). The images were reviewed by a thoracic radiologist, and epidemiological data were collected from patient-filled questionnaires and clinical referrals. Regression models were used in order to control for confounding factors. RESULTS A total of 650 and 760 chest CT scans were reviewed for the 2019 and 2020 samples, respectively. SSNs were found in 10.6% of the patients in the 2019 sample and in 7.9% of those in the 2020 sample (p = 0.10). Multiple SSNs were found in 23 and 11 of the patients in the 2019 and 2020 samples, respectively. Women constituted the majority of the study population. The mean age was 62.8 ± 14.8 years in the 2019 sample and 59.5 ± 15.1 years in the 2020 sample (p < 0.01). COVID-19 accounted for 24% of all referrals for CT examination in 2020. CONCLUSIONS Fewer SSNs were detected on chest CT scans of outpatients during the COVID-19 pandemic than before the pandemic, although the difference was not significant. In addition to COVID-19, the major difference between the 2019 and 2020 samples was the younger age in the 2020 sample. We can assume that fewer SSNs will be detected in a population with a higher proportion of COVID-19 suspicion or diagnosis.
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Affiliation(s)
- Ana Paula Zanardo
- . Programa de Pós-Graduação em Ciências Pneumológicas, Universidade Federal do Rio Grande do Sul, Porto Alegre (RS) Brasil
- . Departamento de Radiologia, Hospital Moinhos de Vento, Porto Alegre (RS) Brasil
| | | | - Rafael Domingos Grando
- . Programa de Pós-Graduação em Ciências Pneumológicas, Universidade Federal do Rio Grande do Sul, Porto Alegre (RS) Brasil
- . Departamento de Radiologia, Hospital Moinhos de Vento, Porto Alegre (RS) Brasil
| | - Rafael Ramos Rambo
- . Programa de Pós-Graduação em Ciências Pneumológicas, Universidade Federal do Rio Grande do Sul, Porto Alegre (RS) Brasil
- . Departamento de Radiologia, Hospital Moinhos de Vento, Porto Alegre (RS) Brasil
| | | | - Luís Carlos Anflor
- . Departamento de Radiologia, Hospital Moinhos de Vento, Porto Alegre (RS) Brasil
- . Departamento de Medicina Interna, Universidade Federal de Ciências da Saúde de Porto Alegre, Porto Alegre (RS) Brasil
| | - Jônatas Fávero Prietto dos Santos
- . Programa de Pós-Graduação em Ciências Pneumológicas, Universidade Federal do Rio Grande do Sul, Porto Alegre (RS) Brasil
- . Departamento de Radiologia, Hospital Moinhos de Vento, Porto Alegre (RS) Brasil
| | - Gabriela Schneider Galvão
- . Programa de Pós-Graduação em Ciências Pneumológicas, Universidade Federal do Rio Grande do Sul, Porto Alegre (RS) Brasil
- . Departamento de Radiologia, Hospital Moinhos de Vento, Porto Alegre (RS) Brasil
| | - Cristiano Feijó Andrade
- . Serviço de Cirurgia Torácica e Pulmonar, Hospital Moinhos de Vento, Porto Alegre (RS) Brasil
- . Serviço de Cirurgia Torácica e Pulmonar, Hospital de Clínicas de Porto Alegre, Porto Alegre (RS) Brasil
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Souza FRD, Rochitte CE, Silva DC, Sampaio B, Passarelli M, Santos MRD, Fonseca GW, Battaglia Filho AC, Correa K, do Val RM, Yonamine M, Pereira RMR, Negrão CE, Kalil-Filho R, Alves MJDNN. Coronary Inflammation by Computed Tomography Pericoronary Fat Attenuation and Increased Cytokines in Young Male Anabolic Androgenic Steroid Users. Arq Bras Cardiol 2023; 120:e20220822. [PMID: 37991119 PMCID: PMC10697680 DOI: 10.36660/abc.20220822] [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] [Received: 12/13/2022] [Revised: 08/09/2023] [Accepted: 08/16/2023] [Indexed: 11/23/2023] Open
Abstract
BACKGROUND Anabolic androgenic steroid (AAS) abuse has been associated with coronary artery disease (CAD). Pericoronary fat attenuation (pFA) is a marker of coronary inflammation, which is key in the atherosclerotic process. OBJECTIVE To evaluate pFA and inflammatory profile in AAS users. METHODS Twenty strength-trained AAS users (AASU), 20 AAS nonusers (AASNU), and 10 sedentary controls (SC) were evaluated. Coronary inflammation was evaluated by mean pericoronary fat attenuation (mPFA) in the right coronary artery (RCA), left anterior descending coronary artery (LAD), and left circumflex (LCx). Interleukin (IL)-1 (IL-1), IL-6, IL-10, and TNF-alpha were evaluated by optical density (OD) in a spectrophotometer with a 450 nm filter. P<0.05 indicated statistical significance. RESULTS AASU had higher mPFA in the RCA (-65.87 [70.51-60.70] vs. -78.07 [83.66-72.87] vs.-78.46 [85.41-71.99] Hounsfield Units (HU), respectively, p<0.001) and mPFA in the LAD (-71.47 [76.40-66.61] vs. -79.32 [84.37-74.59] vs. -82.52 [88.44-75.81] HU, respectively, p=0.006) compared with AASNU and SC. mPFA in the LCx was not different between AASU, AASNU, and SC (-72.41 [77.17-70.37] vs. -80.13 [86.22-72.23] vs. -78.29 [80.63-72.29] HU, respectively, p=0.163). AASU compared with AASNU and SC, had higher IL-1, (0.975 [0.847-1.250] vs. 0.437 [0.311-0.565] vs. 0.530 [0.402-0.780] OD, respectively, p=0.002), IL-6 (1.195 [0.947-1.405] vs. 0.427 [0.377-0.577] vs. 0.605 [0.332-0.950] OD, p=0.005) and IL-10 (1.145 [0.920-1.292] vs. 0.477 [0.382-0.591] vs. 0.340 [0.316-0.560] OD, p<0.001). TNF-α was not different between the AASU, AASNU, and SC groups (0.520 [0.250-0.610] vs. 0.377 [0.261-0.548] vs. 0.350 [0.182-430]), respectively. CONCLUSION Compared with ASSNU and controls, AASU have higher mPFA and higher systemic inflammatory cytokines profile suggesting that AAS may induce coronary atherosclerosis through coronary and systemic inflammation.
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Affiliation(s)
- Francis Ribeiro de Souza
- Instituto do Coração do Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo , São Paulo , SP - Brasil
| | - Carlos E Rochitte
- Instituto do Coração do Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo , São Paulo , SP - Brasil
| | - Douglas Carli Silva
- Faculdade de Medicina da Universidade de São Paulo (FMUSP), São Paulo , SP - Brasil
| | - Barbara Sampaio
- Instituto de Medicina Tropical de São Paulo , São Paulo , SP - Brasil
| | - Marisa Passarelli
- Universidade de São Paulo - Faculdade de Medicina - Laboratório de Lípides , São Paulo , SP - Brasil
- Universidade Nove de Julho , São Paulo , SP - Brasil
| | - Marcelo R Dos Santos
- Instituto do Coração do Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo , São Paulo , SP - Brasil
- Hospital Israelita Albert Einstein , São Paulo , SP - Brasil
| | - Guilherme W Fonseca
- Instituto do Coração do Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo , São Paulo , SP - Brasil
| | - Antonio Carlos Battaglia Filho
- Instituto do Coração do Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo , São Paulo , SP - Brasil
| | - Kelly Correa
- Instituto do Coração do Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo , São Paulo , SP - Brasil
| | - Renata Margarida do Val
- Instituto do Coração do Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo , São Paulo , SP - Brasil
| | - Maurício Yonamine
- Universidade de São Paulo - Faculdade de Ciências Farmacêuticas , São Paulo , SP - Brasil
| | - Rosa Maria R Pereira
- Faculdade de Medicina da Universidade de São Paulo (FMUSP), São Paulo , SP - Brasil
| | - Carlos Eduardo Negrão
- Instituto do Coração do Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo , São Paulo , SP - Brasil
| | - Roberto Kalil-Filho
- Instituto do Coração do Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo , São Paulo , SP - Brasil
- Hospital Sírio Libanês , São Paulo , SP - Brasil
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Ferreira C. The "Value of 0": Is There an Added Value in Using the Calcium Score in the Stratification of Symptomatic Individuals with a Zero Score? Arq Bras Cardiol 2023; 120:e20230105. [PMID: 37042878 PMCID: PMC10399964 DOI: 10.36660/abc.20230105] [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] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/13/2023] Open
Affiliation(s)
- Catarina Ferreira
- Centro Hospitalar de Trás-os-MontesVila RealPortugalS. Cardiologia, Centro Hospitalar de Trás-os-Montes e Alto Douro, Vila Real - Portugal
- Universidade da Beira InteriorFaculdade de Ciências da SaúdeCovilhãPortugalFaculdade de Ciências da Saúde, Universidade da Beira Interior, Covilhã – Portugal
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Baldo MNF, Trad HS, da Silva TJ, Manso PH. Evaluation of Coronary Circulation after Arterial Switch Operation. Arq Bras Cardiol 2021; 116:1111-1116. [PMID: 34133596 PMCID: PMC8288536 DOI: 10.36660/abc.20200095] [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] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2020] [Revised: 04/29/2020] [Accepted: 06/16/2020] [Indexed: 12/31/2022] Open
Abstract
BACKGROUND Coronary artery evaluation remains after arterial switch operation a clinical challenge. OBJECTIVE This study aims to correlate anatomical changes diagnosed by cardiac computed tomography (CCT) with physiological alterations on clinical evaluation to diagnose coronary obstruction in late ASO patients. METHODS This study included 61 consecutive patients with mean age of 9.4 years who underwent ASO. The patients were submitted to echocardiography, electrocardiography, cardiopulmonary exercise test, and cardiac computed tomography to evaluate functional capacity and coronary artery anatomy. RESULTS Cardiac computed tomography revealed that only 3.3% of the patients had coronary stenosis. These patients were asymptomatic, and no signs of myocardial ischemia were detected by the tests. CONCLUSION The incidence of coronary abnormalities in late ASO patients was 3.3% in our cohort. There is no clear guideline as to why, when, and how these patients should be screened or what to propose when a coronary obstruction is diagnosed in asymptomatic patients.
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Affiliation(s)
| | - Henrique Simão Trad
- Lotus RadiologiaRibeirão PretoSPBrasil Lotus Radiologia , Ribeirão Preto , SP – Brasil
| | - Tarcisio José da Silva
- Universidade de São PauloRibeirão PretoSPBrasil Universidade de São Paulo , Ribeirão Preto , SP - Brasil
| | - Paulo Henrique Manso
- Universidade de São PauloRibeirão PretoSPBrasil Universidade de São Paulo , Ribeirão Preto , SP - Brasil
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Scheeren B, Gomes E, Alves G, Marchiori E, Hochhegger B. Chest CT findings in patients with dysphagia and aspiration: a systematic review. J Bras Pneumol 2017; 43:313-318. [PMID: 28767772 PMCID: PMC5687969 DOI: 10.1590/s1806-37562016000000273] [Citation(s) in RCA: 7] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2016] [Accepted: 05/04/2017] [Indexed: 11/21/2022] Open
Abstract
The objective of this systematic review was to characterize chest CT findings in patients with dysphagia and pulmonary aspiration, identifying the characteristics and the methods used. The studies were selected from among those indexed in the Brazilian Virtual Library of Health, LILACS, Indice Bibliográfico Español de Ciencias de la Salud, Medline, Cochrane Library, SciELO, and PubMed databases. The search was carried out between June and July of 2016. Five articles were included and reviewed, all of them carried out in the last five years, published in English, and coming from different countries. The sample size in the selected studies ranged from 43 to 56 patients, with a predominance of adult and elderly subjects. The tomographic findings in patients with dysphagia-related aspiration were varied, including bronchiectasis, bronchial wall thickening, pulmonary nodules, consolidations, pleural effusion, ground-glass attenuation, atelectasis, septal thickening, fibrosis, and air trapping. Evidence suggests that chest CT findings in patients with aspiration are diverse. In this review, it was not possible to establish a consensus that could characterize a pattern of pulmonary aspiration in patients with dysphagia, further studies of the topic being needed.
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Affiliation(s)
- Betina Scheeren
- . Programa de Pós-Graduação em Medicina, Universidade Federal de Ciências da Saúde de Porto Alegre, Porto Alegre (RS) Brasil
| | - Erissandra Gomes
- . Universidade Federal do Rio Grande do Sul, Porto Alegre (RS) Brasil
| | - Giordano Alves
- . Universidade Federal do Rio de Janeiro, Rio de Janeiro (RJ) Brasil
| | - Edson Marchiori
- . Universidade Federal do Rio de Janeiro, Rio de Janeiro (RJ) Brasil
| | - Bruno Hochhegger
- . Programa de Pós-Graduação em Medicina, Universidade Federal de Ciências da Saúde de Porto Alegre, Porto Alegre (RS) Brasil
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Rodrigues MP, Naves LA, Viegas CA, Melo-Silva CA, de Paula WD, Cabral MT, Araújo RR, Casulari LA. Prevalence of lung structure abnormalities in patients with acromegaly and their relationship with gas exchange: cross-sectional analytical study with a control group. SAO PAULO MED J 2015; 133:394-400. [PMID: 26648427 PMCID: PMC10871800 DOI: 10.1590/1516-3180.2013.7640012] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [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: 09/05/2013] [Revised: 03/23/2014] [Accepted: 03/26/2014] [Indexed: 01/15/2023] Open
Abstract
CONTEXT AND OBJECTIVE Different functional respiratory alterations have been described in acromegaly, but their relationship with pulmonary tissue abnormalities is unknown. The objective of this study was to observe possible changes in lung structure and explain their relationship with gas exchange abnormalities. DESIGN AND SETTING Cross-sectional analytical study with a control group, conducted at a university hospital. METHODS The study included 36 patients with acromegaly and 24 controls who were all assessed through high-resolution computed tomography of the thorax (CT). Arterial blood gas, effort oximetry and serum growth hormone (GH) and insulin-like growth factor I (IGF-1) were also assessed in the patients with acromegaly. RESULTS The abnormalities found in the CT scan were not statistically different between the acromegaly and control groups: mild cylindrical bronchiectasis (P = 0.59), linear opacity (P = 0.29), nodular opacity (P = 0.28), increased attenuation (frosted glass; P = 0.48) and decreased attenuation (emphysema; P = 0.32). Radiographic abnormalities were not associated with serum GH and IGF-1. Hypoxemia was present in seven patients; however, in six of them, the hypoxemia could be explained by underlying clinical conditions other than acromegaly: chronic obstructive pulmonary disease in two, obesity in two, bronchial infection in one and asthma in one. CONCLUSION No changes in lung structure were detected through thorax tomography in comparison with the control subjects. The functional respiratory alterations found were largely explained by alternative diagnoses or had subclinical manifestations, without any plausible relationship with lung structural factors.
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Affiliation(s)
- Marcelo Palmeira Rodrigues
- MD, MSc, PhD. Adjunct Professor of Pneumology, School of Medicine, Universidade de Brasília (UnB), Brasília, Brazil
| | - Luciana Ansaneli Naves
- MD, MSc, PhD. Adjunct Professor of Endocrinology, School of Medicine, Universidade de Brasília (UnB), Brasília, Brazil
| | - Carlos Alberto Viegas
- MD, MSc, PhD. Adjunct Professor of Pneumology, School of Medicine, Universidade de Brasília (UnB), Brasília, Brazil
| | - Cesar Augusto Melo-Silva
- MSc, PhD. Physiotherapist, Department of Pneumology, Hospital Universitário de Brasília (HUB), Brasília, Brazil
| | - Wagner Diniz de Paula
- MD. Physician, Department of Radiology, Hospital Universitário de Brasília (HUB), Brasília, Brazil
| | - Márcia Teixeira Cabral
- MD. Physician, Department of Radiology, Hospital Universitário de Brasília (HUB), Brasília, Brazil
| | - Renata Rodrigues Araújo
- MD. Physician, Department of Pneumology, Hospital Universitário de Brasília (HUB), Brasília, Brazil
| | - Luiz Augusto Casulari
- MD, MSc, PhD. Physician, Department of Endocrinology, Hospital Universitário de Brasília (HUB), Universidade de Brasília (UnB), Brasília, Brazil
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Boechat MCB, Mello RRD, Silva KSD, Daltro P, Marchiori E, Ramos EG, Dutra MVP. A computed tomography scoring system to assess pulmonary disease among premature infants. SAO PAULO MED J 2010; 128:328-35. [PMID: 21308155 PMCID: PMC10948065 DOI: 10.1590/s1516-31802010000600004] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.6] [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: 09/18/2010] [Revised: 09/18/2010] [Accepted: 09/30/2010] [Indexed: 11/21/2022] Open
Abstract
CONTEXT AND OBJECTIVE High-resolution computed tomography (HRCT) is considered to be the best method for detailed pulmonary evaluation. The aim here was to describe a scoring system based on abnormalities identified on HRCT among premature infants, and measure the predictive validity of the score in relation to respiratory morbidity during the first year of life. DESIGN AND SETTING Prospective cohort study in Instituto Fernandes Figueira, Fundação Oswaldo Cruz. METHODS Scoring system based on HRCT abnormalities among premature newborns. The affected lung area was quantified according to the number of compromised lobes, in addition to bilateral pulmonary involvement. Two radiologists applied the score to 86 HRCT scans. Intraobserver and interobserver agreement were analyzed. The score properties were calculated in relation to predictions of respiratory morbidity during the first year of life. RESULTS Most of the patients (85%) presented abnormalities on HRCT, and among these, 56.2% presented respiratory morbidity during the first year of life. Scores ranged from zero to 12. There was good agreement between observers (intraclass correlation coefficient, ICC = 0.86, confidence interval, CI: 0.64-0.83). The predictive scores were as follows: positive predictive value 81.8%, negative predictive value 56.3%, sensitivity 39.1%, and specificity 90.0%. CONCLUSION The scoring system is reproducible, easy to apply and allows HRCT comparisons among premature infants, by identifying patients with greater likelihood of respiratory morbidity during the first year of life. Its use will enable HRCT comparisons among premature infants with different risk factors for respiratory morbidity.
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MESH Headings
- Epidemiologic Methods
- Humans
- Infant
- Infant, Newborn
- Infant, Premature
- Infant, Premature, Diseases/diagnostic imaging
- Infant, Premature, Diseases/mortality
- Infant, Premature, Diseases/pathology
- Lung Diseases/diagnostic imaging
- Lung Diseases/mortality
- Lung Diseases/pathology
- Tomography, X-Ray Computed/methods
- Tomography, X-Ray Computed/standards
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Boëchat MCB, Mello RRD, Dutra MVP, Silva KSD, Daltro P, Marchiori E. Intra and interobserver reliability of the interpretation of high-resolution computed tomography on the lungs of premature infants. SAO PAULO MED J 2010; 128:130-6. [PMID: 20963364 PMCID: PMC10938957 DOI: 10.1590/s1516-31802010000300005] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [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: 12/22/2008] [Revised: 04/04/2010] [Accepted: 04/04/2010] [Indexed: 11/22/2022] Open
Abstract
CONTEXT AND OBJECTIVE High-resolution computed tomography (HRCT) of the lungs is more sensitive than radiographs for evaluating pulmonary disease, but little has been described about HRCT interpretation during the neonatal period or shortly afterwards. The aim here was to evaluate the reliability of the interpretation of HRCT among very low birth weight premature infants (VLBWPI; < 1500 g). DESIGN AND SETTING Cross-sectional study on intra and interobserver reliability of HRCT on VLBWPI. METHODS 86 VLBWPI underwent HRCT. Two pediatric radiologists analyzed the HRCT images. The reliability was measured by the proportion of agreement, kappa coefficient (KC) and positive and negative agreement indices. RESULTS For radiologist A, the intraobserver reliability KC was 0.79 (confidence interval, CI: 0.54-1.00) for normal/abnormal examinations; for each abnormality on CT, KC ranged from 0.05 to 1.00. For radiologist B, the intraobserver reliability KC was 0.79 (CI: 0.54-1.00) for normal/abnormal examinations; for each abnormality on CT, KC ranged from 0.37 to 0.83. The interobserver agreement was 88% for normal/abnormal examinations and KC was 0.71 (CI: 0.5- 0.93); for most abnormal findings, KC ranged from 0.51-0.67. CONCLUSION For normal/abnormal examinations, the intra and interobserver agreements were substantial. For most of the imaging findings, the intraobserver agreement ranged from moderate to substantial. Our data demonstrate that in clinical practice, there is no reason for more than one tomographic image evaluator, provided that this person is well trained in VLBWPI HRCT interpretation. Analysis by different observers should be reserved for research and for difficult cases in clinical contexts.
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