A spatio-temporal image analysis for growth of indeterminate pulmonary nodules detected by CT scan.

The objective is to evaluate the performance of computational image classification for indeterminate pulmonary nodules (IPN) chronologically detected by CT scan. Total 483 patients with 670 abnormal pulmonary nodules, who were taken chest thin-section CT (TSCT) images at least twice and resected as suspicious nodules in our hospital, were enrolled in this study. Nodular regions from the initial and the latest TSCT images were cut manually for each case, and approached by Python development environment, using the open-source cv2 library, to measure the nodular change rate (NCR). These NCRs were statistically compared with clinico-pathological factors, and then, this discriminator was evaluated for clinical performance. NCR showed significant differences among the nodular consistencies. In terms of histological subtypes, NCR of invasive adenocarcinoma (ADC) were significantly distinguishable from other lesions, but not from minimally invasive ADC. Only for cancers, NCR was significantly associated with loco-regional invasivity, p53-immunoreactivity, and Ki67-immunoreactivity. Regarding Epidermal Growth Factor Receptor gene mutation of ADC-related nodules, NCR showed a significant negative correlation. On staging of lung cancer cases, NCR was significantly increased with progression from pTis-stage 0 up to pT1b-stage IA2. For clinical shared decision-making (SDM) whether urgent resection or watchful-waiting, receiver operating characteristic (ROC) analysis showed that area under the ROC curve was 0.686. For small-sized IPN detected by CT scan, this approach shows promise as a potential navigator to improve work-up for life-threatening cancer screening and assist SDM before surgery.

Small-sized Pulmonary Adenocarcinoma Manifesting Skip-like Transition from Nonsolid Nodule: A Case Report.

This report shows a case with a rare small-sized lung adenocarcinoma that rapidly progressed from a nonsolid nodule (NSN) to a solid nodule (SON) over a period of just 1 year after a very long-term observation from its first detection. In 2007, the patient was an asymptomatic 52-year-old man at the time of the first detection via chest low-dose computed tomography (CT) screening as part of a periodic medical checkup at our hospital. It revealed an abnormal shadow in another location of the lung field, necessitating a more thorough examination. Then, he visited our outpatient clinic for the first time and a workup examination was performed using thin-section CT (TSCT) images, which incidentally detected a small NSN with a maximum diameter of 1.2 cm in the mid-zone of the left upper lung field. Since it did not disappear in the periodic subsequent workup examinations, the patient was informed of the suspicious early lung adenocarcinoma each time; however, the patient desired to continue watchful waiting. The radiographical properties of the NSN remained almost unchanged until 2019, but in 2020, the inside of the nodule showed a skip-like change to a SON. Finally, because of the unexpectedly fast transition, consent for lobectomy could be obtained. Surgery was then performed, 13 years after its first detection, at an age of 65 years. The pathological findings revealed a 1.2 cm, pT1bN0M0, pStage IA2-adenocarcinoma, which was 90% of the acinar subtype with positive vascular permeation. Management of a NSN, that does not resolve and/or change, must continue watchful waiting, and at the very least continue follow-up with TSCT observation to ensure the safe and appropriate timing of excision using imaging as a marker of transition.

Preoperative Watchful-Waiting Time and Surgical Outcome of Patients with Non-small Cell Lung Cancer Found by Chest Low-Dose CT Screening.

BACKGROUNDS: Chest low-dose CT screening (LDCTS) has been finding unprecedented numbers of peripheral non-small cell lung cancers (NSCLC) at an early stage and increased the number of patients with surgical indication. It is important to explore the influence of preoperative watchful-waiting time (WWT) on surgical outcomes. Objective is to clarify relationship between WWT and surgical outcomes of LDCTS-finding NSCLC from the view point of treatment delay. METHODS: Total 283 cases of NSCLC, found by LDCTS and consecutively resected, were surveyed for preoperative WWT and surgical outcomes. Validity of the present guideline for management of pulmonary nodules detected by LDCTS was verified whether WWT before surgery was suitable for eradication of NSCLC. RESULTS: The median value of WWT was 4.0 months in total, and the distribution of WWT exhibited long-tail-type pattern. That was 5.0 months in the group of pure ground-glass nodule (pGGN), 4.0 months in the group of part-solid nodule (PSN), and 1.7 months in the group of solid nodule (SON). During long-term postoperative observation time (median 79 months), 10-year progression-free survival rates were 100% in pGGN, 96% in PSN, and 72% in SON (P < .0001). They decreased significantly depending on enlargement of size: 91% or higher in size of 2 cm or smaller, and 71% or lower in size of larger than 2 cm (P < .0001). CONCLUSIONS: Limited to LDCTS-finding nodules, surgical outcome will depend mainly on some malignant potential of NSCLC per se, rather than on duration of WWT or treatment delay.

Pulmonary adenocarcinoma possibly developed from the cut-end of small-sized adenocarcinoma in the lung periphery as recurrence 13 years after its wedge resection.

BACKGROUND: It is a big topic for general thoracic surgery whether still curability can be obtained by limited resection for peripheral small-sized nodules of non-small cell lung cancer (NSCLC) in the current era of frequent computed tomography (CT) use. Accumulation of information on problematic cases would be meaningful for surgeons to select better surgical procedures. CASE PRESENTATION: A 69-year-old man was pointed out an enlarged 2.1-cm solid nodule on the edge of staple line of the residual right upper lobe by chest CT. He had past history of the lung cancer surgery, wedge resection of the same right upper lobe 13 years ago. The pathological findings were 1.1-cm, p-TlbN0M0, p-stage IA2-adenocarcinoma. Thereafter, he received no adjuvant therapy. This time, the trans-bronchial lung biopsy revealed adenocarcinoma. After the completion lobectomy of the residual right upper lobe, the tumor was diagnosed as adenocarcinoma consistent with recurrence of small-sized adenocarcinoma in the lung periphery developed from the cut-end because of similarities between present and previous tumors on histopathology and p53-positivity. CONCLUSIONS: When limited resection has been performed for small-sized NSCLC presenting solid nodule on thin-slice CT images, long-term postoperative follow-up time will be necessary for monitoring, considering the possibility of cut-end recurrence.

Presence of local pleural adhesion in CT screening-detected small nodule in the lung periphery suggests noncancerous, inflammatory nature of the lesion.

PURPOSE: Differential diagnosis of small nodules in the lung periphery detected by low-dose chest CT screening is important before surgery. The aim of the study was to discriminate between benign and malignant lesions, identified in our preoperative imaging work-up examinations and confirmed during surgery, for nodules detected on CT screening. MATERIALS AND METHODS: This study is based on 106 patients (46 men and 60 women, median age: 61.5 years) with 123 CT screening-detected and histologically confirmed nodules smaller than 30 mm in the lung periphery identified between 2002 and 2005 at Azumi General Hospital, Japan. Lesions were classified into three groups according to histological findings: adenocarcinoma, atypical adenomatous hyperplasia (AAH) and inflammatory focal lesions. We examined the visceral pleura during surgery at a location close to lung nodules. RESULTS: The median diameter of resected lung nodules on high-resolution CT (HRCT) was 9.0 mm. Nodules were nonsolid in 42, partly solid in 51 and solid in 30. Histopathological diagnosis was lung cancer in 69, AAH in 21, other noninflammatory tumours in 6 and inflammatory lesions in 27. Fifty-four lesions were located in the subpleural zone. Eight of 123 nodules showed local pleural adhesions (LPA), while 2 were buried in extensive pleural adhesion. LPA was noted more frequently in inflammatory nodules than in cancer nodules (P<.01). CONCLUSION: The presence of LPA in close proximity to a small nodule is indicative of noncancerous lesion. This feature allows the discrimination of pulmonary peripheral inflammatory lesion from peripheral small cancer on chest low-dose CT screening.

[An octogenarian case of postoperative recurrent lung cancer responding to treatments with radiation plus gefitinib].

An 82-year-old woman, a never smoker, had a radical operation for CT screening revealed lung cancer in an other hospital in 1997. She was admitted to our hospital complaining of dry cough and dyspnea on effort in March 2004. She was diagnosed to have a local recurrence of lung cancer 6 years after the operation. After she underwent radiotherapy of the mediastinum (total 60 Gy) and daily administration of gefitinib for two weeks, the administration of gefitinib was continued every other day in the outpatient clinic. During follow-up, CYFRA gradually increased to 3.8 ng/mL, but then decreased to the normal range. The tumor response rate of metastasized lymph nodes of bronchial bifurcation reached 36%, and it was confirmed to be a partial response. Without harmful phenomena except skin eruptions, her quality of life was good with a performance status (PS) 0 at 85 years 4 months of age, 9 years 2 months after the resection, with 2 years 5 months of gefitinib administration. It will be useful as a treatment option for octogenarians having postoperative recurrent lung cancers with every other day administration of gefitinib.

Second-line chemotherapy of platinum compound plus CPT-11 following ADOC chemotherapy in advanced thymic carcinoma: analysis of seven cases.

BACKGROUND: Optimal chemotherapeutic regimen in thymic carcinoma remains uncertain and the efficacy of second line chemotherapy has not been established either. PATIENTS AND METHODS: We retrospectively evaluated the efficacy of an irinotecan plus cisplatin or carboplatin (IP) regimen as a salvage treatment for patients with unresectable thymic carcinoma that progressed after cisplatin, doxorubicin, vincristine and cyclophosphamide (ADOC) chemotherapy. Seven patients with histologically confirmed thymic carcinoma that was resistant to or who had relapsed after initial chemotherapy with ADOC were treated with IP. The treatment consisted of irinotecan (CPT-11, 60 mg/m2, days 1, 8 and 15) and cisplatin (80 mg/m2, day 1) or carboplatin (AUC 4) intravenously every 4 weeks, for at least 2 cycles. RESULT: Two patients achieved partial responses. Although another two patients showed a significant reduction of the primary thoracic lesion, the appearance of a new lesion was found in one and a metastatic lesion was unchanged in the other. Neutropenia over grade 3 was observed in all patients but none of the patients developed serious infections. There were no severe non-hematological toxicities, including diarrhea. CONCLUSION: We conclude that salvage chemotherapy may be useful in certain patients with thymic carcinoma and irinotecan may be a novel and alternative agent for relapsed thymic carcinoma.

Relationship between sleep-disordered breathing and lifestyle-related illnesses in subjects who have undergone health-screening.

OBJECTIVE: Simplified sleep polysomnography was performed in 207 adult men to examine the relationship between the frequency of sleep-disordered breathing (SDB) and lifestyle-related illness. METHODS: Each subject was checked for SDB using a simplified sleep polysomnograph (Auto-Set Portable; Teijin Limited, Tokyo, Japan). Apnea and hypopnea were detected with a nasal cannula type airflow sensor. Hypoxemia was checked with a percutaneous oxygen saturation (SpO2) monitor. We analyzed the relationships between SDB and body mass index (BMI) and hypertension, hyperlipidemia, liver dysfunction, fatty liver, and abnormal glucose metabolism. RESULTS: Fifty-nine subjects (29%) showed SDB with apnea hypopnea index (AHI) over 15 times/h. The frequency of obesity (BMI > or = 25), hypertension, hypercholesterolemia, fasting blood glucose level, and HbA1c were significantly higher in patients with SDB than in normal individuals (AHI < 5 times/h). The frequencies of hypertension, hyperlipidemia, and abnormal glucose metabolism were compared between the obesity-free normal AHI group and the SDB group, and only that of hypertension was significantly different between the two groups. CONCLUSIONS: The present study revealed a high frequency of SDB among Japanese individuals. The results also suggest that as SDB becomes severe, it becomes more closely linked to the onset of lifestyle-related illnesses, such as hypertension, hypercholesterolemia and abnormal glucose metabolism.

Salvage chemotherapy with carboplatin and paclitaxel for cisplatin-resistant thymic carcinoma--three cases.

The optimal chemotherapeutic regimen for thymic carcinoma remains uncertain and the utility of salvage therapy has also not been reported. Three cases of unresectable and locally advanced thymic carcinoma, resistant to prior chemotherapy with cisplatin are reported. These patients were treated with carboplatin and paclitaxel chemotherapy, as salvage chemotherapy. Although concomitant thoracic radiotherapy was performed in one patient, two showed a partial response and the other showed a minor response after carboplatin and paclitaxel chemotherapy. Thymic carcinoma is sensitive to platinum-based chemotherapy and paclitaxel appears to have significant activity against thymic carcinoma.

[Successful treatment of intrapericardial administration of carboplatin following systemic chemotherapy in a case of advanced thymic cancer with cardiac tamponade].

A 72-year-old woman developed cardiac tamponade due to direct invasion of thymic cancer. Carboplatin was administered into the pericardial cavity two times with a total dose of 600 mg. Pericardial effusion disappeared without any toxicities. Following four cycles of systemic chemotherapy by carboplatin, doxorubicin, vincristine, cyclophosphamide (ADOC), partial response was obtained. She is alive 10 month after being given a diagnosis of cardiac tamponade. Intrapericardial administration of carboplatin is a useful therapy for control of pericardial effusion and chemosensitive cases should de identified among patients with thymic cancer.

[Investigation of a pulmonary tuberculosis outbreak].

Diagnoses of infectious tuberculosis (TB) patients were followed by thorough contact investigation on the basis of our hospital's Infectious Disease Manual ever since an infection of an inpatient with extended hospital stay was confirmed by a positive acid-fast sputum smear in October 1998. In September 2000, a nurse was found to have pulmonary TB and another was given a diagnosis of right tuberculous pleuritis the following November. Contact investigations were expedited among all hospital staff, families of the infected nurses, and all suspected inpatients. Five were diagnosed as TB, 8 were given chemoprophylaxis and 8 others required observation. The result verified a TB outbreak within the hospital, and management of TB infection control was re-enforced subsequently. We concluded that immediate contact investigation promoted successful early diagnosis, and reacknowledged the significance of the health supervision of all staff, operations including the environment and equipment control of the institution, and frequent contact and integration with the administration of the public health center. This experience enabled a useful revision of the disease manual for the future.