Application of computer-aided detection for NCCN-based follow-up recommendation in subsolid nodules: Effect on inter-observer agreement.

RATIONALE AND OBJECTIVES: Computer-aided detection (CAD) of pulmonary nodules reduces the impact of observer variability, improving the reliability and reproducibility of nodule assessments in clinical practice. Therefore, this study aimed to assess the impact of CAD on inter-observer agreement in the follow-up management of subsolid nodules. MATERIALS AND METHODS: A dataset comprising 60 subsolid nodule cases was constructed based on the National Cancer Center lung cancer screening data. Five observers independently assessed all low-dose computed tomography scans and assigned follow-up management strategies to each case according to the National Comprehensive Cancer Network (NCCN) guidelines, using both manual measurements and CAD assistance. The linearly weighted Cohen's kappa test was used to measure agreement between paired observers. Agreement among multiple observers was evaluated using the Fleiss kappa statistic. RESULTS: The agreement of the five observers for NCCN follow-up management categorization was moderate when measured manually, with a Fleiss kappa score of 0.437. Utilizing CAD led to a notable enhancement in agreement, achieving a substantial consensus with a Fleiss kappa value of 0.623. After using CAD, the proportion of major and substantial management discrepancies decreased from 27.5% to 15.8% and 4.8% to 1.5%, respectively (p < 0.01). In 23 lung cancer cases presenting as part-solid nodules, CAD significantly elevates the average sensitivity in detecting lung cancer cases presenting as part-solid nodules (overall sensitivity, 82.6% vs. 92.2%; p < 0.05). CONCLUSION: The application of CAD significantly improves inter-observer agreement in the follow-up management strategy for subsolid nodules. It also demonstrates the potential to reduce substantial management discrepancies and increase detection sensitivity in lung cancer cases presenting as part-solid nodules.

Efficacy and safety assessment on herbs invigorating spleen and removing dampness, blood stasis and toxin combined with chemotherapy in the treatment of advanced colorectal cancer / 肿瘤研究与临床

Objective To evaluate systematically whether or not the treatment of herbs invigorating spleen and removing dampness,blood stasis and toxin with chemotherapy is better than chemotherapy alone for advanced colorectal cancer.Methods The randomized controlled trails (RCT) involving combined treatment of herbs with chemotherapy,published from January 2000 to October 2015,were searched in CBM,CNKI,Wanfang Data,VIP,PubMed,Embase databases.Stata 14.0 software was used to analyze the data.Results 19 RCT containing 941 patients were included in this reta-analysis.Compared with chemotherapy alone,the combined treatment of Chinese herbal medicine and chemotherapy was obviously better in 1-year survival rate (RR =1.28,95 ％ CI 1.14-1.45),2-year survival rate (RR =1.52,95 ％ CI 1.05-2.18),3-year survival rate (RR =2.76,95 ％ CI 1.56-4.88),objective response (RR =1.11,95 ％ CI 1.04-1.19),Karnofsky score (RR =1.46,95 ％ CI 1.27-1.68) and traditional chinese medicine (TCM) symptom score (RR =1.58,95 ％ CI 1.33-1.75).The adverse effect rate was statistically reduced in the combined treatment group:leukopenia (RR =0.59,95 ％ CI 0.40-0.8),nausea and vomiting (RR =0.68,95 ％ CI 0.59-0.79),diarrhea (RR =0.67,95 ％ CI 0.53-0.85),neurotoxicity (RR =0.79,95 ％ CI 0.65-0.96).Conclusion Compared with chemotherapy alone,the treatment of herbs invigorating spleen and removing dampness,blood stasis and toxin combined with chemotherapy for advanced colorectal cancer can significantly increase survival rate and objective response rate,improve the quality of life,and meanwhile decrease the adverse effect rate.