Performance of the Vancouver Risk Calculator Compared with Lung-RADS in an Urban, Diverse Clinical Lung Cancer Screening Cohort.

Purpose: To compare the performance of the Vancouver risk calculator (VRC) with the American College of Radiology's Lung CT Screening Reporting and Data System (Lung-RADS) for a lung cancer screening cohort in an urban, diverse clinical setting. Materials and Methods: This study included a total of 486 patients with lung nodules (63 years ± 5.2 [standard deviation], 261 female patients), 448 of whom had lung nodules that were subsequently classified as benign and 38 of whom had those that were classified as malignant. The mean follow-up time was 40.0 months ± 14. Institutional review board approval was obtained for this Health Insurance Portability and Accountability Act-compliant retrospective study, and a waiver of informed consent was received. All patients undergoing lung cancer screening who underwent an initial baseline screening CT between December 2012 and June 2016 that demonstrated a nodule and had at least 1 year of follow-up comprised the study population. Each examination was assigned a Lung-RADS score between 2 and 4B, with 4A and 4B considered as showing positive results. The VRC calculates the risk of cancer at different thresholds using nine variables related to patient and imaging characteristics. Analysis was performed per patient based on the largest nodule. Lung-RADS and VRC using the 5% threshold were compared to assess diagnostic performance in determining the risk of developing lung cancer in a patient with a nodule found at screening CT. The McNemar test was used to compare differences in performance between Lung-RADS and VRC. Results: Lung-RADS resulted in nine false-positive and 16 false-negative findings, whereas VRC with a 5% threshold resulted in 29 false-positive and 10 false-negative findings. Overall sensitivity and specificity for Lung-RADS was 58.0% and 98.0%, and for VRC with a 5% threshold was 73.7% and 93.5%, respectively (P = .313, P < .001, respectively). Conclusion: The VRC performs well in an urban, diverse lung cancer screening program. Further studies may be directed at determining whether its use in conjunction with Lung-RADS leads to improved lung cancer detection.Keywords: CT, Lung, Thorax© RSNA, 2020.

Effectiveness of Lung-RADS in Reducing False-Positive Results in a Diverse, Underserved, Urban Lung Cancer Screening Cohort.

PURPOSE: The Lung CT Screening Reporting and Data SystemTM (Lung-RADSTM) was created to standardize lung cancer screening CT reporting and recommendations but has not been well validated prospectively in clinical practice. The aim of this study was to determine the effectiveness of lung cancer screening using Lung-RADS in a diverse, underserved, academic clinical screening program, focusing on whether Lung-RADS would successfully reduce the 23.3% false-positive rate found in the National Lung Screening Trial. METHODS: Institutional review board approval was obtained to study the clinical lung cancer screening cohort. Low-dose CT results were prospectively assigned a Lung-RADS or equivalent score. The proportion of examinations in each Lung-RADS category and the corresponding lung cancer rate, subsequent imaging, interventions, mortality, and compliance were tracked. The National Death Index was queried for follow-up losses. RESULTS: The cohort comprised 1,181 patients with 2,270 person-years of follow-up from December 2012 to December 2016. The mean age was 64 ± 16.2 years, with 51% women, 63% nonwhite, 71% current smokers, 69% overweight and obese, and multiple comorbidities. The Lung-RADS false-positive rate was 10.4% (95% confidence interval, 8.8%-12.3%). Baseline CT results were negative in 87% (n = 1,031): for Lung-RADS 1, the lung cancer rate was 0.2%, and for Lung-RADS 2, the cancer rate was 0.5%. Positive baseline examinations were Lung-RADS 3 in 10% (n = 119), 4a in 1.2% (n = 14), and 4b in 1.5% (n = 18). Corresponding cancer rates were 3.4%, 43%, and 83%, respectively. Lung cancer prevalence was 2.1%. Mortality was 40% in patients with lung cancer versus 2.5% in the remaining cohort (P < .001). Fifty-four percent of patients were overdue for first annual examinations. Eighty-four percent of patients (n = 989) had follow-up verified via electronic records or personal contact, and the remainder had vital status ascertained via the National Death Index. CONCLUSIONS: Lung cancer screening using Lung-RADS was effective in reducing the false-positive rate compared with the National Lung Screening Trial in a diverse and underserved urban population.

Tourette syndrome associated with body temperature dysregulation: possible involvement of an idiopathic hypothalamic disorder.

Tourette syndrome is a neuropsychiatric disorder that holds the potential to afflict the emotional, familial, social, or scholastic performances of patients with Tourette syndrome in day-to-day life functioning. The disorder is today characterized mainly and diagnosed by clinical observations, yet false-negative results obtained in the diagnosis of Tourette syndrome are numerous and well documented. There is still no laboratory or imaging technique available for the diagnosis of Tourette syndrome. This article reports on changes of the ambient thermal perception (38%) and a circadian dysregulation of the body-temperature profile present in Tourette syndrome probands, irrespective of their chronologic age, sex, or comorbid symptoms. An involvement of idiopathic hypothalamic dysfunctions associated with Tourette syndrome is proposed. Such a phenomenon, if substantiated, could lead to a better understanding of Tourette syndrome and the development of unbiased physical diagnostic criteria of Tourette syndrome and potentiate possible production of novel therapeutic possibilities.

Effects of medications on regulation of body temperature of patients with Tourette syndrome.

Tourette syndrome is defined and characterized mainly by the presence of motor and phonic tics. Frequently, other medical, psychologic, and psychiatric symptoms coincide with Tourette syndrome. Despite extensive efforts extended over many years of research, the etiology leading to Tourette syndrome remains obscure. A number of hypotheses have been offered in the past to resolve the pathophysiology of Tourette syndrome. Based on the existence of an abnormal body temperature profile in patients with Tourette syndrome, an idiopathic hypothalamic disorder has been proposed to be involved in this ailment. When monitoring the effects of medications employed in the consensus for Tourette syndrome treatments, it became evident that medications ameliorate neurologic tics and rectify the patient's periodic hypothermal body temperature. Correlating the neurologic status to hypothalamic dysregulation, the data presented in this study strengthen the hypothesis of an idiopathic hypothalamic disorder underlying the Tourette syndrome cascade.

Platelet-associated antibodies mediate protective autoimmune response in schizophrenia.

The peripheral blood platelets of schizophrenic patients were isolated, and the level of the platelet-associated antibodies (SPAA) was correlated with the rating scores of discrete schizophrenic symptom clusters evaluated with the Brief Psychiatric Rating Scale. Irrespective of medication and gender, symptom-dependent correlations were established between the SPAA levels and the relevant psychometric scores. The results indicate a heterogeneous origin of schizophrenia and imply the involvement of an autoimmune arm as a predominantly protective immune response.