Evaluation of the correlation between trigeminal nerve atrophy and trigeminal neuralgia using multimodal image fusion: A single-center retrospective study.

BACKGROUND: 3D-Slicer is an open-source medical image processing and visualization software. In the surgical treatment of trigeminal neuralgia, it is commonly used to predict the responsible vessels. However, there are few reports on the use of 3D-Slicer software to quantitatively measure the bilateral trigeminal nerve volume in patients with primary trigeminal neuralgia (PTN) based on the three-dimensional images. Therefore, this study aims to explore the role of three-dimensional fused images processed by 3D-Slicer in the evaluation of trigeminal nerve atrophy, providing an objective basis for the diagnosis of PTN. METHODS: 57 PTN patients who underwent microvascular decompression (MVD) or percutaneous balloon compression (PBC) surgery in Hebei general hospital between January 2020 and April 2023 were included. Additionally, 30 patients with facial spasms(HFS) were included as a control group. All patients underwent 3D-TOF-MRA and 3D-FIESTA sequence examinations. Comparisons of bilateral trigeminal nerve volumes within and between groups were conducted by performing image fusion using 3D-slicer. RESULTS: The volume of the affected trigeminal nerve in the MVD group (33.96 mm³±12.61 mm³) and PBC group (23.05 mm³±7.71 mm³) was smaller than that of the unaffected trigeminal nerve in the MVD group (39.61 mm³±12.83 mm³) and PBC group (26.14 mm³±6.42 mm³), as well as the average volume of the trigeminal nerve in the control group (40.27 mm³±10.25 mm³) (P<0.05). The differences in bilateral trigeminal ganglion volume (∆V) was significant between the MVD group (∆V=23.59 %±14.32 %) and the control group (∆V=14.64 %±10.00 %) (P<0.05). There was no statistical difference in the trigeminal nerve volume difference between the MVD group (∆V=23.59 %±14.32 %) and the PBC group (∆V=26.52 %±15.00 %) (P>0.05). CONCLUSION: Trigeminal nerve atrophy is correlated with primary trigeminal neuralgia. 3D-slicer software can quantitatively measure trigeminal nerve volume and assist in the diagnosis of primary trigeminal neuralgia based on the difference in bilateral trigeminal nerve volumes. However, trigeminal nerve atrophy is not associated with postoperative pain recurrence in patients.

Enhancing Visualization of the Foramen Ovale in Percutaneous Microcompression: A Preoperative Image Simulation Technique.

OBJECTIVE: Introducing a preoperative image simulation technique to streamline the visualization of the foramen ovale in percutaneous microcompression. METHODS: Twenty-five trigeminal neuralgia patients were included in the study. Preoperative cranial computed tomography scans were processed with 3D Slicer software to create simulated fluoroscopic skulls. The angulations required for precise visualization of the foramen ovale were established via simulated anteroposterior imaging. These simulations informed the C-arm's angulations for foramen ovale targeting during surgery. RESULTS: The preoperative simulations accurately forecasted skull rotation angulations, aligning closely with intraoperative observations with negligible discrepancies (0-2 degrees). In 17 patients, the foramen ovale was distinctly visible, while in 8 patients, it was partially obscured yet discernible using the simulated angles. Nonvisible of the foramen ovale did not occur. Postoperative pain relief and complications were recorded. CONCLUSIONS: Based on our initial findings, the application of preoperative image simulation shows significant referential value in achieving accurate visualization of the foramen ovale in percutaneous microcompression for trigeminal neuralgia.

Efficacy and safety of Dyna CT-assisted percutaneous balloon compression in the treatment of tumor-related trigeminal neuralgia: A single-center retrospective analysis.

BACKGROUND: Percutaneous balloon compression (PBC) has been widely used in the treatment of trigeminal neuralgia (TN). Patients with tumor-related TN are typically treated by tumor resection. However, when craniotomy is not feasible, PBC may serve as a simple and effective method for pain relief. Currently, there is limited literature on the use of this technique in treating patients with tumor-related TN. In this study, we aim to evaluate the efficacy and safety of Dyna CT-assisted PBC in the treatment of tumor-related TN. METHODS: From January 2018 to December 2023, a total of 19 patients with tumor-related TN underwent Dyna CT-assisted PBC at our institution. The modified Barrow Neurological Institute Pain Intensity Grading Scale and sensory reduction scores were employed to assess treatment outcomes. A retrospective analysis was conducted on the clinical characteristics, surgical efficacy, postoperative complications, and follow-up results of all patients. RESULTS: Immediate and complete pain relief was observed in 18 patients following PBC, with one patient experiencing delayed recovery. Follow-up periods ranged from 4 to 62 months, revealing only 4 patients with pain recurrence at the last follow-up, and tumor-related TN patients with involvement of Meckel's cave were more prone to recurrence. No severe complications occurred throughout the follow-up period. Although facial numbness was reported in all 15 patients, jaw weakness in 8 patients, and postoperative headache in 7 patients, these symptoms resolved within a short period. There were no statistically significant differences in postoperative facial numbness and jaw weakness between tumor-related TN patients with or without Meckel's cave involvement. However, patients with Meckel's cave involvement were more likely to experience postoperative headaches. Patient satisfaction scores indicated a significant improvement in postoperative quality of life. CONCLUSION: For patients with tumor-related TN, when craniotomy is not feasible, Dyna CT-assisted PBC proves to be a safe and effective alternative treatment. Additionally, we observed varying postoperative clinical outcomes based on the different sites of tumor compression on the trigeminal nerve. Patients with tumor-related TN not involving Meckel's cave exhibited more enduring clinical efficacy compared to those with Meckel's cave involvement.

Ct-defined emphysema prevalence in a Chinese and Dutch general population.

PURPOSE: We determine and compare the prevalence, subtypes, severity, and risk factors for emphysema assessed by low-dose CT(LDCT) in Chinese and Dutch general populations. METHODS: This cross-sectional study included LDCT scans of 1143 participants between May and October 2017 from a Chinese Cohort study and 1200 participants with same age range and different smoking status between May and October 2019 from a Dutch population-based study. An experienced radiologist visually assessed the scans for emphysema presence (≥trace), subtype, and severity. Logistic regression analyses, overall and stratified by smoking status, were performed and adjusted for fume exposure, demographic and smoking data. RESULTS: The Chinese population had a comparable proportion of women to the Dutch population (54.9 % vs 58.9 %), was older (61.7 ± 6.3 vs 59.8 ± 8.1), included more never smokers (66.4 % vs 38.3 %), had a higher emphysema prevalence ([58.8 % vs 39.7 %], adjusted odds ratio, aOR = 2.06, 95 %CI = 1.68-2.53), and more often had centrilobular emphysema (54.8 % vs 32.8 %, p < 0.001), but no differences in emphysema severity. After stratification, only in never smokers an increased odds of emphysema was observed in the Chinese compared to the Dutch (aOR = 2.55, 95 %CI = 1.95-3.35). Never smokers in both populations shared older age (aOR = 1.59, 95 %CI = 1.25-2.02 vs 1.26, 95 %CI = 0.97-1.64) and male sex (aOR = 1.50, 95 %CI = 1.02-2.22 vs 1.93, 95 %CI = 1.26-2.96) as risk factors for emphysema. CONCLUSIONS: Only never smokers had a higher prevalence of mainly centrilobular emphysema in the Chinese general population compared to the Dutch after adjusting for confounders, indicating that factors other than smoking, age and sex contribute to presence of CT-defined emphysema.

Who is at risk of lung nodules on low-dose CT in a Western country? A population-based approach.

BACKGROUND: This population-based study aimed to identify the risk factors for lung nodules in a Western European general population. METHODS: We quantified the presence or absence of lung nodules among 12 055 participants of the Dutch population-based ImaLife (Imaging in Lifelines) study (age ≥45 years) who underwent low-dose chest computed tomography. Outcomes included the presence of 1) at least one solid lung nodule (volume ≥30 mm3) and 2) a clinically relevant lung nodule (volume ≥100 mm3). Fully adjusted multivariable logistic regression models were applied overall and stratified by smoking status to identify independent risk factors for the presence of nodules. RESULTS: Among the 12 055 participants (44.1% male; median age 60 years; 39.9% never-smokers; 98.7% White), we found lung nodules in 41.8% (5045 out of 12 055) and clinically relevant nodules in 11.4% (1377 out of 12 055); the corresponding figures among never-smokers were 38.8% and 9.5%, respectively. Factors independently associated with increased odds of having any lung nodule included male sex, older age, low educational level, former smoking, asbestos exposure and COPD. Among never-smokers, a family history of lung cancer increased the odds of both lung nodules and clinically relevant nodules. Among former and current smokers, low educational level was positively associated with lung nodules, whereas being overweight was negatively associated. Among current smokers, asbestos exposure and low physical activity were associated with clinically relevant nodules. CONCLUSIONS: The study provides a large-scale evaluation of lung nodules and associated risk factors in a Western European general population: lung nodules and clinically relevant nodules were prevalent, and never-smokers with a family history of lung cancer were a non-negligible group.

Pricing and cost-saving potential for deep-learning computer-aided lung nodule detection software in CT lung cancer screening.

OBJECTIVE: An increasing number of commercial deep learning computer-aided detection (DL-CAD) systems are available but their cost-saving potential is largely unknown. This study aimed to gain insight into appropriate pricing for DL-CAD in different reading modes to be cost-saving and to determine the potentially most cost-effective reading mode for lung cancer screening. METHODS: In three representative settings, DL-CAD was evaluated as a concurrent, pre-screening, and second reader. Scoping review was performed to estimate radiologist reading time with and without DL-CAD. Hourly cost of radiologist time was collected for the USA (€196), UK (€127), and Poland (€45), and monetary equivalence of saved time was calculated. The minimum number of screening CTs to reach break-even was calculated for one-time investment of €51,616 for DL-CAD. RESULTS: Mean reading time was 162 (95% CI: 111-212) seconds per case without DL-CAD, which decreased by 77 (95% CI: 47-107) and 104 (95% CI: 71-136) seconds for DL-CAD as concurrent and pre-screening reader, respectively, and increased by 33-41 s for DL-CAD as second reader. This translates into €1.0-4.3 per-case cost for concurrent reading and €0.8-5.7 for pre-screening reading in the USA, UK, and Poland. To achieve break-even with a one-time investment, the minimum number of CT scans was 12,300-53,600 for concurrent reader, and 9400-65,000 for pre-screening reader in the three countries. CONCLUSIONS: Given current pricing, DL-CAD must be priced substantially below €6 in a pay-per-case setting or used in a high-workload environment to reach break-even in lung cancer screening. DL-CAD as pre-screening reader shows the largest potential to be cost-saving. CRITICAL RELEVANCE STATEMENT: Deep-learning computer-aided lung nodule detection (DL-CAD) software must be priced substantially below 6 euro in a pay-per-case setting or must be used in high-workload environments with one-time investment in order to achieve break-even. DL-CAD as a pre-screening reader has the greatest cost savings potential. KEY POINTS: • DL-CAD must be substantially below €6 in a pay-per-case setting to reach break-even. • DL-CAD must be used in a high-workload screening environment to achieve break-even. • DL-CAD as a pre-screening reader shows the largest potential to be cost-saving.

Lifestyle factors related to prevalent chronic disease multimorbidity: A population-based cross-sectional study.

BACKGROUND: Multimorbidity is associated with poor quality of life, polypharmacy, health care costs and mortality, with those affected potentially benefitting from a healthy lifestyle. We assessed a comprehensive set of lifestyle factors in relation to multimorbidity with major chronic diseases. METHODS: This cross-sectional study utilised baseline data for adults from the prospective Lifelines Cohort in the north of the Netherlands (N = 79,345). We defined multimorbidity as the co-existence of two or more chronic diseases (i.e. cardiovascular disease, cancer, respiratory disease, type 2 diabetes) and evaluated factors in six lifestyle domains (nutrition, physical (in)activity, substance abuse, sleep, stress, relationships) among groups by the number of chronic diseases (≥2, 1, 0). Multinomial logistic regression models were created, adjusted for appropriate confounders, and odds ratios (OR) with 95% confidence intervals (95%CI) were reported. RESULTS: 3,712 participants had multimorbidity (4.7%, age 53.5 ± 12.5 years), and this group tended to have less healthy lifestyles. Compared to those without chronic diseases, those with multimorbidity reported physical inactivity more often (OR, 1.15; 95%CI, 1.06-1.25; not significant for one condition), chronic stress (OR, 2.14; 95%CI, 1.92-2.38) and inadequate sleep (OR, 1.70; 95%CI, 1.41-2.06); as expected, they more often watched television (OR, 1.70; 95%CI, 1.42-2.04) and currently smoked (OR, 1.91; 95%CI, 1.73-2.11), but they also had lower alcohol intakes (OR, 0.66; 95%CI, 0.59-0.74). CONCLUSIONS: Chronic stress and poor sleep, in addition to physical inactivity and smoking, are lifestyle factors of great concern in patients with multimorbidity.

Effective Control of Postoperative Cerebrospinal Fluid Leakage by Modified Microvascular Decompression in Patients with Hemifacial Spasm.

Objective: This study aimed to compare the clinical outcomes of a modified microvascular decompression (MVD) with a traditional MVD in hemifacial spasm. Methods: A tota1 of 120 patients with hemifacial spasm who received a modified MVD (modified MVD group) and 115 patients who received a traditional MVD (traditional MVD group) from January 2013 to March 2021 were retrospectively reviewed. The surgery efficiency rate, surgery time and postoperative complications in both groups were recorded and analyzed. Results: There was no significant difference between the 2 groups regarding surgery: efficiency rate (modified MVD group VS traditional MVD group: 92.50% vs 92.17%, respectively; P = .925). The intracranial surgery time and postoperative complications rate in the modified MVD group were significantly lower than in the traditional MVD group (31.00 ± 1.78 min vs 48.00 ± 1.74 min, respectively; P < .05; 8.33% vs 20.87%; P = .006, respectively). There was no statistical difference between open skull time and close skull time between the 2 groups (modified MVD group vs traditional MVD group: 38.50 ± 1.76 min vs 40.00 ± 1.78 min, respectively; P = .055; 38.50 ± 1.76 min vs 36.00 ± 1.78 min, respectively; P = .086). Conclusion: The modified MVD for hemifacial spasm can achieve satisfactory clinical outcomes and reduce intracranial surgery time and postoperative complications.

CT-based emphysema characterization per lobe: A proof of concept.

PURPOSE: The Fleischner society criteria are global criteria to visually evaluate and classify pulmonary emphysema on CT. It may group heterogeneous disease severity within the same category, potentially obscuring clinically relevant differences in emphysema severity. This proof-of-concept study proposes to split emphysema into more categories and to assess each lobe separately, and applies this to two general population-based cohort samples to assess what information such an extension adds. METHOD: From a consecutive sample in two general population-based cohorts with low-dose chest CT, 117 participants with more than a trace of emphysema were included. Two independent readers performed an extended per-lobe classification and assessed overall severity semi-quantitatively. An emphysema sum score was determined by adding the severity score of all lobes. Inter-reader agreement was quantified with Krippendorff Alpha. RESULTS: Based on Fleischner society criteria, 69 cases had mild to severe centrilobular emphysema, and 90 cases had mild or moderate paraseptal emphysema (42 had both types of emphysema). The emphysema sum score was significantly different between mild (10.7 ± 4.3, range 2-22), moderate (20.1 ± 3.1, range: 15-24), and severe emphysema (23.6 ± 3.4, range: 17-28, p < 0.001), but ranges showed significant overlap. Inter-reader agreement for the extended classification and sum score was substantial (alpha 0.79 and 0.85, respectively). Distribution was homogenous across lobes in never-smokers, yet heterogenous in current smokers, with upper-lobe predominance. CONCLUSIONS: The proposed emphysema evaluation method adds information to the original Fleischner society classification. Individuals in the same Fleischner category have diverse emphysema sum scores, and lobar emphysema distribution differs between smoking groups.

Risk factors for cardiac rupture after acute ST-segment elevation myocardial infarction during the percutaneous coronary intervention era: a retrospective case-control study.

Background: In percutaneous coronary intervention (PCI) era, more clinically valuable risk factors are still needed to determine the occurrence of cardiac rupture (CR). Therefore, we aimed to provide evidence for the early identification of CR in ST-segment elevation myocardial infarction (STEMI). Methods: A total of 22,016 consecutive patients with STEMI admitted to Cangzhou Central Hospital and Tianjin Chest Hospital from January 2013 to July 2021 were retrospectively included, among which 195 patients with CR were included as CR group. From the rest 21,820 STEMI patients without CR, 390 patients at a ratio of 1:2 were included as the control group. A total of 66 patients accepted PCI in the CR group, and 132 patients who accepted PCI in the control group at a ratio of 1:2 were included. The status of first medical contact, laboratory examinations, and PCI characteristics were recorded. Multivariate logistic regression analysis was used to investigate the risk factors related to CR. Results: There was a higher proportion of patients with myocardial infarction (MI) in the high lateral wall in the CR group (23.6% vs. 8.2%, P<0.001). The proportion of single lesions was lower in the CR group (24.2% vs. 45.5%, P=0.004). Female (OR =2.318, 95% CI: 1.431-3.754, P=0.001), age (OR =1.066, 95% CI: 1.041-1.093, P<0.001), smoking (OR =1.750, 95% CI: 1.086-2.820, P=0.022), total chest pain time (OR =1.017, 95% CI: 1.000-1.035, P=0.049), recurrent acute chest pain (OR =2.750, 95% CI: 1.535-4.927, P=0.001), acute myocardial infarction (AMI) in the high lateral wall indicated by ECG (OR =5.527, 95% CI: 2.798-10.918, P<0.001), acute heart failure (OR =3.585, 95% CI: 2.074-6.195, P<0.001), and NT-proBNP level (OR =1.000, 95% CI: 1.000-1.000, P=0.023) were risk factors for CR in all patients. In patients who accepted PCI, single lesion (OR =0.421, 95% CI: 0.204-0.867, P=0.019), preoperative thrombolysis in myocardial infarction (TIMI) grade (OR =0.358, 95% CI: 0.169-0.760, P=0.007), and postoperative TIMI grade (OR =0.222, 95% CI: 0.090-0.546, P=0.001) were risk factors for CR. Conclusions: Non-single lesions and preoperative and postoperative TIMI grades were risk factors for CR in patients who accepted PCI. In addition to previously reported indicators, we found that AMI in the high lateral wall maybe helpful in early and accurate identification and prevention of possible CR.

Airflow Limitation Increases Lung Cancer Risk in Smokers: The Lifelines Cohort Study.

BACKGROUND: The relationship between smoking, airflow limitation, and lung cancer occurrence is unclear. This study aims to evaluate the relationship between airflow limitation and lung cancer, and the effect modification by smoking status. METHODS: We included participants with spirometry data from Lifelines, a population-based cohort study from the Northern Netherlands. Airflow limitation was defined as FEV1/FVC ratio < 0.7. The presence of pathology-confirmed primary lung cancer during a median follow-up of 9.5 years was collected. The Cox regression model was used and hazard ratios (HR) with 95% confidence interval (95% CI) were reported. Adjusted confounders included age, sex, educational level, smoking, passive smoking, asthma status and asbestos exposure. The effect modification by smoking status was investigated by estimating the relative excess risk due to interaction (RERI) and the ratio of HRs with 95% CI. RESULTS: Out of 98,630 participants, 14,200 (14.4%) had airflow limitation. In participants with and without airflow limitation, lung cancer incidence was 0.8% and 0.2%, respectively. The adjusted HR between airflow limitation and lung cancer risk was 1.7 (1.4-2.3). The association between airflow limitation and lung cancer differed by smoking status [former smokers: 2.1 (1.4-3.2), current smokers: 2.2 (1.5-3.2)] and never smokers [0.9 (0.4-2.1)]. The RERI and ratio of HRs was 2.1 (0.7-3.4) and 2.5 (1.0-6.5) for former smokers, and 4.6 (95% CI, 1.8-7.4) and 2.5 (95% CI, 1.0-6.3) for current smokers, respectively. CONCLUSIONS: Airflow limitation increases lung cancer risk and this association is modified by smoking status. IMPACT: Ever smokers with airflow limitation are an important target group for the prevention of lung cancer.

The preoperative evaluation value of 3D-slicer program before microsurgical vascular decompression in patients with hemifacial spasm.

BACKGROUND: To compare the diagnostic accuracy of 3D fast imaging employing steady-state acquisition (FIESTA) combined with 3D-time-of-flight (TOF) MR angiography (MRA) sequences (FTMS) and 3D-reconstuction synthesized by 3D-slicer program in evaluation the neurovascular relationships and offending vessels preoperatively in patients with hemifacial spasm (HFS). METHODS: Clinical data of HFS patients who underwent microsurgical vascular decompression (MVD) were analyzed. All patients underwent MRA scans with FTMS and 3D-reconstruction before surgery. The neurovascular relationship and offending vessels were evaluated and compared with intraoperative findings. RESULTS: Forty patients were included in this study, 18 (45%) of them were male. The mean age was 49.6 years. The Kappa identity tests identified the agreement between the FTMS and intraoperative findings in evaluating the neurovascular relationship and offending vessel was 0.263 and 0.643, respectively. The agreement between the 3D-reconstruction and intraoperative findings was 0.633 and 0.921 respectively. There was borderline significant difference between the two methods in predicting neurovascular relationship (χ2 = 9.363, P = 0.053), and there were significant differences between the two methods in predicting offending vessels (χ2 = 188.408, P < 0.001). The sensitivity and specificity of FTMS in evaluating the neurovascular relationship were 89.7% and 100%, respectively, while those with 3D-reconstruction were both 100%. Moreover, the correct 3D- reconstruction examinations in predicting vessel and nerve relationships (r = 0.634, P = 0.034) and offending vessels (r = 0.652, P = 0.028) were significantly correlated with completely symptoms remission. CONCLUSIONS: The 3D-reconstuction synthesized by 3D-slicer program was more accurate than FTMS in preoperative evaluation of neurovascular relationship and offending vessel. The technique is expected to be helpful in preoperative evaluation. AVAILABILITY OF DATA AND MATERIAL: The dataset used and/or analyzed during the current study are available from the corresponding author on reasonable request.

Lung cancer screening with low-dose CT: Simulating the effect of starting screening at a younger age in women.

BACKGROUND: The US has recently lowered the entry age for lung cancer screening with low-dose computed tomography (LDCT) from 55 to 50 years. The effect of the younger age for starting screening on the rates of screen-detected and radiation-induced lung cancers in women remains unclear. METHODS: A modeling study was conducted. A static cohort of 100,000 heavy female smokers was simulated to undergo annual lung cancer screening with LDCT. The number of screen-detected lung cancers (benefit) and radiation-induced lung cancers (harm) per 1000 screenees were calculated for scenarios with two starting ages (55-50 years) and fixed stopping age (75 years). The benefit-harm ratio and incremental benefit-harm ratio (IBHR) were calculated for each scenario. RESULTS: For annual screening from 55 to 75 years, the number of screen-detected and radiation-induced lung cancers was 112.4 and 2.2, respectively. For annual screening from 50 to 75 years, those numbers were 117.0 and 3.4, respectively. The benefit-harm ratio decreased from 51 to 35 and the IBHR decreased from 6.3 to 4.0 when lowering the screening starting age from 55 to 50 years. CONCLUSIONS: The risk of radiation induced lung cancers increased by 50% when lowering the screening starting age by 5 years in women. However, the benefits of LDCT lung cancer screening still outweigh the assumed radiation harm.

Performance of a deep learning-based lung nodule detection system as an alternative reader in a Chinese lung cancer screening program.

OBJECTIVE: To evaluate the performance of a deep learning-based computer-aided detection (DL-CAD) system in a Chinese low-dose CT (LDCT) lung cancer screening program. MATERIALS AND METHODS: One-hundred-and-eighty individuals with a lung nodule on their baseline LDCT lung cancer screening scan were randomly mixed with screenees without nodules in a 1:1 ratio (total: 360 individuals). All scans were assessed by double reading and subsequently processed by an academic DL-CAD system. The findings of double reading and the DL-CAD system were then evaluated by two senior radiologists to derive the reference standard. The detection performance was evaluated by the Free Response Operating Characteristic curve, sensitivity and false-positive (FP) rate. The senior radiologists categorized nodules according to nodule diameter, type (solid, part-solid, non-solid) and Lung-RADS. RESULTS: The reference standard consisted of 262 nodules ≥ 4 mm in 196 individuals; 359 findings were considered false positives. The DL-CAD system achieved a sensitivity of 90.1% with 1.0 FP/scan for detection of lung nodules regardless of size or type, whereas double reading had a sensitivity of 76.0% with 0.04 FP/scan (P = 0.001). The sensitivity for detection of nodules ≥ 4 - ≤ 6 mm was significantly higher with DL-CAD than with double reading (86.3% vs. 58.9% respectively; P = 0.001). Sixty-three nodules were only identified by the DL-CAD system, and 27 nodules only found by double reading. The DL-CAD system reached similar performance compared to double reading in Lung-RADS 3 (94.3% vs. 90.0%, P = 0.549) and Lung-RADS 4 nodules (100.0% vs. 97.0%, P = 1.000), but showed a higher sensitivity in Lung-RADS 2 (86.2% vs. 65.4%, P < 0.001). CONCLUSIONS: The DL-CAD system can accurately detect pulmonary nodules on LDCT, with an acceptable false-positive rate of 1 nodule per scan and has higher detection performance than double reading. This DL-CAD system may assist radiologists in nodule detection in LDCT lung cancer screening.

Cost-effectiveness of lung cancer screening by low-dose CT in China: a micro-simulation study.

Background: The effectiveness of lung cancer screening with low-dose computed tomography (LDCT) has been established. The current study evaluates the cost-effectiveness of lung cancer screening with LDCT in a general population in China. Methods: A previously validated micro-simulation model was used to simulate a cohort of men and women on a lifetime horizon in the presence and absence of LDCT screening. The modeling data were collected from numerous national and international sources. Simulated screening scenarios included different combinations of screening intervals and start and stop ages. Additional costs (valued in Chinese Yuan, CNY; 1 USD = 6.8976 CNY, 1 EUR = 7.8755 CNY in 2020), life-years gained (LYG) and mortality reduction due to screening were also determined. The costs and life-years were discounted by 3%. All results were scaled to 1,000 individuals. The average cost-effectiveness ratio (ACER) was calculated. A willingness-to-pay threshold of CNY 217.3k / LYG was considered. A healthcare system perspective was adopted. Results: Compared to no screening, lung cancer screening by LDCT in a general Chinese population yielded 21.0 - 36.7 LYG in men and 9.2 - 16.6 LYG in women across the scenarios. For men, biennial LDCT screening yielded an ACER of CNY 171.4k - 306.3k / LYG relative to no screening. Biennial screening performed between 55 and 75 years of age was optimal at the defined threshold; it resulted in CNY 174.6k / LYG and a lung cancer mortality reduction of 9.1%, and this scenario had a 75% probability of being cost-effective. For women, the ACER ranged from CNY 364.2k to 1193.3k / LYG. Conclusions: In China, lung cancer screening with LDCT in the general population including never smokers could be cost-effective for men with 75% probability, but not for women. The optimal strategy for men would be performing biennial screening between 55 and 75 years of age.

Community-based lung cancer screening by low-dose computed tomography in China: First round results and a meta-analysis.

OBJECTIVE: To evaluate the efficiency of low-dose computed tomography (LDCT) screening for lung cancer in China by analyzing the baseline results of a community-based screening study accompanied with a meta-analysis. METHODS: A first round of community-based lung cancer screening with LDCT was conducted in Tianjin, China, and a systematic literature search was performed to identify LDCT screening and registry-based clinical studies for lung cancer in China. Baseline results in the community-based screening study were described by participant risk level and the lung cancer detection rate was compared with the pooled rate among the screening studies. The percentage of patients per stage was compared between the community-based study and screening and clinical studies. RESULTS: In the community-based study, 5523 participants (43.6% men) underwent LDCT. The lung cancer detection rate was 0.5% (high-risk, 1.2%; low-risk, 0.4%), with stage I disease present in 70.0% (high-risk, 50.0%; low-risk, 83.3%), and the adenocarcinoma present in 84.4% (high-risk, 61.5%; low-risk, 100%). Among all screen-detected lung cancer, women accounted for 8.3% and 66.7% in the high- and low-risk group, respectively. In the screening studies from mainland China, the lung cancer detection rate 0.6% (95 %CI: 0.3%-0.9%) for high-risk populations. The proportions with carcinoma in situ and stage I disease in the screening and clinical studies were 76.4% (95 %CI: 66.3%-85.3%) and 15.2% (95 %CI: 11.8%-18.9%), respectively. CONCLUSIONS: The stage shift of lung cancer due to screening suggests a potential effectiveness of LDCT screening in China. Nearly 70% of screen-detected lung cancers in low-risk populations are identified in women.

Comparison of National Comprehensive Cancer Network and European Position Statement protocols for nodule management in low-dose computed tomography lung cancer screening in a general Chinese population.

BACKGROUND: Low-dose computed tomography (LDCT) lung cancer screening often refers individuals to unnecessary examinations. This study aims to compare the European Position Statement (EUPS) and National Comprehensive Cancer Network (NCCN) protocols in management of participants at baseline screening round. METHODS: LDCT lung cancer screening was prospectively performed in a Chinese asymptomatic population aged 40-74 years. A total of 1,000 consecutive baseline LDCT scans were read twice independently. All screen-detected lung nodules by the first reader were included. The first reader manually measured the diameter of lung nodules (NCCN protocol), and the second reader semi-automatically measured the volume and diameter (EUPS volume and diameter protocols). The protocols were used to classify the participants into three management groups: next screening round, short-term repeat LDCT scan and referral to a pulmonologist. Groups were compared using Wilcoxon test for paired samples. Number of lung cancers by protocols was provided. RESULTS: Of the 1,000 participants (61.4±6.7 years old), 168 lung nodules in 124 participants were visually detected and manually measured in the first reading, and re-measured semi-automatically. Applying the NCCN protocol, EUPS volume and diameter protocol, the proportion of referrals among all participants was 0.6%, 1.9%, and 1.4%, respectively. The proportion of short-term repeat scans was 4.5%, 9.7% and 4.5%, respectively. Among the 10 lung cancer patients, one would have been diagnosed earlier if the EUPS volume protocol would have been followed. CONCLUSIONS: In a first round screening in a Chinese general population, the lower threshold for referral in the EUPS protocol as compared to the NCCN protocol, leads to more referrals to a pulmonologist, with the potential of earlier cancer diagnosis. The EUPS volume protocol recommends fewer participants to short-term repeat LDCT scan than the EUPS diameter protocol. Follow-up studies should show the impact of both protocols on (interval) cancer diagnosis.

Computed Tomography Screening for Early Lung Cancer, COPD and Cardiovascular Disease in Shanghai: Rationale and Design of a Population-based Comparative Study.

RATIONALE AND OBJECTIVES: To describe the rational and design of a population-based comparative study. The objective of the study is to assess the screening performance of volume-based management of CT-detected lung nodule in comparison to diameter-based management, and to improve the effectiveness of CT screening for chronic obstructive pulmonary disease (COPD) and cardiovascular disease (CVD), in addition to lung cancer, based on quantitative measurement of CT imaging biomarkers in a Chinese screening setting. MATERIALS AND METHODS: A population-based comparative study is being performed, including 10,000 asymptomatic participants between 40 and 74 years old from Shanghai urban population. Participants in the intervention group undergo a low-dose chest and cardiac CT scan at baseline and 1 year later, and are managed according to NELCIN-B3 protocol. Participants in the control group undergo a low-dose chest CT scan according to the routine CT protocol and are managed according to the clinical practice. Epidemiological data are collected through questionnaires. In the fourth year from baseline, the diagnosis of the three diseases will be collected. RESULTS: The unnecessary referral rate will be compared between NELCIN-B3 and standard protocol for managing early-detected lung nodules. The effectiveness of quantitative measurement of CT imaging biomarkers for early detection of lung cancer, COPD and CVD will be evaluated. CONCLUSION: We expect that the quantitative assessment of the CT imaging biomarkers will reduce the number of unnecessary referrals for early detected lung nodules, and will improve the early detection of COPD and CVD in a Chinese urban population. TRIAL REGISTRATION: ClinicalTrials.gov, NCT03988322. Registered on 14 June 2019.

Supplementary data for a model-based health economic evaluation on lung cancer screening with low-dose computed tomography in a high-risk population.

This supplementary data is supportive to the research article entitled 'Cost-effectiveness of lung cancer screening with low-dose computed tomography (LDCT) in heavy smokers: A micro-simulation modelling study' (Yihui Du et al. 2020). This supplementary contains a description of the model input and the related model output data that were not included in the research article. The input data used for the tumour growth model and the self-detected tumour size model are provided. The output data of this article include the data used for cost-effectiveness analysis of lung cancer LDCT screening with the Dutch and international discount rates, the data of the sensitivity analysis, and the data of the model validation.

Cost-effectiveness of lung cancer screening with low-dose computed tomography in heavy smokers: a microsimulation modelling study.

BACKGROUND: Lung cancer screening with low-dose computed tomography (LDCT) reduces lung cancer mortality. The aim of this study was to evaluate the cost-effectiveness of lung cancer screening with LDCT in a high-risk population. METHODS: The study used an adapted microsimulation model in a cohort of Dutch heavy smokers for a lifetime horizon from a health insurance perspective. The main outcomes included average cost-effectiveness ratio (ACER), incremental cost-effectiveness ratio (ICER) and lung cancer mortality reduction. The comparator was no screening. Scenarios with different screening intervals and starting and stopping ages were evaluated for 100,000 male heavy smokers and 100,000 female heavy smokers. A cost-effectiveness threshold of 60 k€ per life year gained (LYG) was assumed acceptable. RESULTS: The evaluated screening scenarios yielded ACERs ranging from 17.7 to 32.4 k€/LYG for men and from 17.8 to 32.1 k€/LYG for women. The lung cancer mortality reduction ranged from 9.3% to 16.8% for men and from 7.8% to 13.7% for women. The optimal screening scenario was annual screening from 55 to 80 years for men and biennial screening from 50 to 80 years for women, with an ICER of 51.6 and 45.8 k€ per LYG compared with its previous efficient alternative, respectively. Compared with no screening, the optimal screening scenario yielded an ICER of 27.6 k€/LYG for men and 21.1 k€/LYG for women. The mortality reduction of lung cancer was 15.9% for men and 10.6% for women. CONCLUSIONS: Lung cancer LDCT screening is cost-effective in a high-risk population. The optimal screening scenario is dependent on sex.