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1.
J Med Case Rep ; 15(1): 196, 2021 Apr 25.
Artículo en Inglés | MEDLINE | ID: mdl-33894773

RESUMEN

BACKGROUND: Thoracoscopic segmentectomy of the lateral and posterior basal segments is extremely technically challenging. Appropriate segmentectomy requires exposure and recognition of the branches of the bronchi and pulmonary vessels deep in the lung parenchyma. Although various approaches for these segmentectomies have been reported, the use of a pulmonary ligament approach is rational because it does not require any interlobar separation. Here, we report a successful case of portal robotic segmentectomy of the lateral and posterior basal segments through the pulmonary ligament approach. CASE PRESENTATION: A 60-year-old Japanese man with a history of low anterior resection for rectal cancer was referred to our department because of a lung nodule. His chest computed tomography revealed a 15-mm tumor in the left posterior basal bronchus. Robotic left S9-10 segmentectomy through the pulmonary ligament was performed with five-port incisions. CONCLUSIONS: An extremely technically challenging thoracoscopic segmentectomy of the lateral and posterior basal segments was performed through the pulmonary ligament using a robotic surgical system.


Asunto(s)
Ligamentos/cirugía , Mastectomía Segmentaria/métodos , Neumonectomía/métodos , Procedimientos Quirúrgicos Robotizados/métodos , Humanos , Neoplasias Pulmonares/diagnóstico por imagen , Neoplasias Pulmonares/cirugía , Masculino , Persona de Mediana Edad , Robótica , Toracoscopía , Resultado del Tratamiento
2.
Medicine (Baltimore) ; 100(16): e25663, 2021 Apr 23.
Artículo en Inglés | MEDLINE | ID: mdl-33879750

RESUMEN

ABSTRACT: Along with recent developments in deep learning techniques, computer-aided diagnosis (CAD) has been growing rapidly in the medical imaging field. In this work, we evaluate the deep learning-based CAD algorithm (DCAD) for detecting and localizing 3 major thoracic abnormalities visible on chest radiographs (CR) and to compare the performance of physicians with and without the assistance of the algorithm. A subset of 244 subjects (60% abnormal CRs) was evaluated. Abnormal findings included mass/nodules (55%), consolidation (21%), and pneumothorax (24%). Observer performance tests were conducted to assess whether the performance of physicians could be enhanced with the algorithm. The area under the receiver operating characteristic (ROC) curve (AUC) and the area under the jackknife alternative free-response ROC (JAFROC) were measured to evaluate the performance of the algorithm and physicians in image classification and lesion detection, respectively. The AUCs for nodule/mass, consolidation, and pneumothorax were 0.9883, 1.000, and 0.9997, respectively. For the image classification, the overall AUC of the pooled physicians was 0.8679 without DCAD and 0.9112 with DCAD. Regarding lesion detection, the pooled observers exhibited a weighted JAFROC figure of merit (FOM) of 0.8426 without DCAD and 0.9112 with DCAD. DCAD for CRs could enhance physicians' performance in the detection of 3 major thoracic abnormalities.


Asunto(s)
Aprendizaje Profundo/estadística & datos numéricos , Enfermedades Pulmonares/diagnóstico por imagen , Interpretación de Imagen Radiográfica Asistida por Computador/estadística & datos numéricos , Radiografía Torácica/estadística & datos numéricos , Neoplasias Torácicas/diagnóstico por imagen , Anciano , Área Bajo la Curva , Estudios de Casos y Controles , Femenino , Humanos , Neoplasias Pulmonares/diagnóstico por imagen , Masculino , Persona de Mediana Edad , Variaciones Dependientes del Observador , Neumotórax/diagnóstico por imagen , Curva ROC , Interpretación de Imagen Radiográfica Asistida por Computador/métodos , Radiografía Torácica/métodos , Reproducibilidad de los Resultados
3.
J Med Case Rep ; 15(1): 205, 2021 Apr 28.
Artículo en Inglés | MEDLINE | ID: mdl-33906689

RESUMEN

BACKGROUND: The median sternotomy approach in sleeve pneumonectomy enables diseased lung ventilation in selected cases, which may reduce the difficulty in achieving anastomosis under intubation of the left main bronchus. However, with median sternotomy, the ascending aorta requires repeated mobilization to expose the operative field for anastomosis, which can cause an aortogenic embolic stroke. CASE PRESENTATION: A 70-year-old Asian man presenting 6 months after developing hemoptysis was diagnosed with right upper lobe lung cancer (stage T4N0M0), invading the lower trachea and basal bronchus. Preoperative computed tomography revealed ascending aorta calcification. Right sleeve pneumonectomy was performed using median sternotomy with diseased lung ventilation. The ascending aorta was repeatedly mobilized to adequately expose the tracheobronchial bifurcation. Surgery was uneventful, but he did not recover complete consciousness even after termination of anesthesia. Mild paralysis of both upper extremities was observed. Head magnetic resonance imaging on postoperative day 1 revealed multiple small acute infarctions in the brain, possibly caused by mobilization of the aorta. He received anticoagulation therapy and rehabilitation and was discharged on postoperative day 30. CONCLUSION: The median sternotomy approach in sleeve pneumonectomy enables diseased lung ventilation. However, the possibility of aortogenic embolic stroke should be considered when calcification of the ascending aorta is observed on preoperative computed tomography.


Asunto(s)
/etiología , Neoplasias Pulmonares/complicaciones , Neoplasias Pulmonares/cirugía , Neumonectomía/efectos adversos , Esternotomía/efectos adversos , Anciano , Bronquios , Humanos , Neoplasias Pulmonares/diagnóstico por imagen , Masculino , Recurrencia Local de Neoplasia
4.
Artículo en Inglés | MEDLINE | ID: mdl-33801033

RESUMEN

There has been growing interest in utilizing information from cone-beam computed tomography (CBCT) to help guide both treatment delivery and prognosis. In this assessment of locally advanced unresectable stage III non-small cell lung cancer (NSCLC) treated with definitive chemoradiation, we aimed to determine the survival advantage associated with using CBCT to measure tumor regression. Patient, tumor, and treatment characteristics were collected. The serial tumor shrinkage for each patient was determined from tumor volume contours on weekly CBCTs. Survival analysis was performed using the Kaplan-Meier technique and a Cox proportional hazards model. At least two-thirds of patients had a tumor volume reduction of at least 5% after each week of chemoradiation. A weekly reduction in tumor volume of 5% or greater seen on the CBCT images during radiation therapy was significantly associated with improved overall survival, which remained significant when adjusted for age, histology, grade, and T- and N-stages (p = 0.0036). Additionally, the presence of N3 disease was associated with a five-fold increased risk of recurrence (p = 0.0006) and a nearly three-fold increased risk of death (p = 0.053) compared with N0-N2 disease. Tumor volume shrinkage observed in the CBCT images during definitive chemoradiation holds promise as a prognostic indicator of stage III NSCLC, especially given its affordability, availability, and applicability. Further evaluation in a prospective fashion is warranted to validate the tumor volume shrinkage and its clinical utility.


Asunto(s)
Carcinoma de Pulmón de Células no Pequeñas , Neoplasias Pulmonares , Tomografía Computarizada de Haz Cónico Espiral , Carcinoma de Pulmón de Células no Pequeñas/diagnóstico por imagen , Carcinoma de Pulmón de Células no Pequeñas/terapia , Tomografía Computarizada de Haz Cónico , Humanos , Neoplasias Pulmonares/diagnóstico por imagen , Neoplasias Pulmonares/terapia , Recurrencia Local de Neoplasia , Proyectos Piloto , Pronóstico , Estudios Prospectivos
5.
Eur J Radiol ; 138: 109664, 2021 May.
Artículo en Inglés | MEDLINE | ID: mdl-33798933

RESUMEN

INTRODUCTION: Distant metastases are found in the many of patients with lung cancer at time of diagnosis. Several diagnostic tools are available to distinguish between metastatic spread and benign lesions in the adrenal gland. However, all require additional diagnostic steps after the initial CT. The purpose of this study was to evaluate if texture analysis of CT-abnormal adrenal glands on the initial CT correctly differentiates between malignant and benign lesions in patients with confirmed lung cancer. MATERIALS AND METHODS: In this retrospective study 160 patients with endoscopic ultrasound-guided biopsy from the left adrenal gland and a contrast-enhanced CT in portal venous phase were assessed with texture analysis. A region of interest encircling the entire adrenal gland was used and from this dataset the slice with the largest cross section of the lesion was analyzed individually. RESULTS: Several texture parameters showed statistically significantly difference between metastatic and benign lesions but with considerable between-groups overlaps in confidence intervals. Sensitivity and specificity were assessed using ROC-curves, and in univariate binary logistic regression the area under the curve ranged from 36 % (Kurtosis 0.5) to 69 % (Entropy 2.5) compared to 73 % in the best fitting model using multivariate binary logistic regression. CONCLUSION: In lung cancer patients with abnormal adrenal gland at imaging, adrenal gland texture analyses appear not to have any role in discriminating benign from malignant lesions.


Asunto(s)
Neoplasias de las Glándulas Suprarrenales , Neoplasias Pulmonares , Neoplasias de las Glándulas Suprarrenales/diagnóstico por imagen , Diagnóstico Diferencial , Humanos , Neoplasias Pulmonares/diagnóstico por imagen , Estudios Retrospectivos , Sensibilidad y Especificidad , Tomografía Computarizada por Rayos X
6.
Kyobu Geka ; 74(3): 191-195, 2021 Mar.
Artículo en Japonés | MEDLINE | ID: mdl-33831871

RESUMEN

The incidence of postoperative pulmonary torsion is not frequent but it has a high mortality rate once it occurs, and prompt diagnosis and treatment are required. From past reports, it is considered effective to point out disruption of pulmonary blood flow by contrast-enhanced computed tomography (CT) examination for diagnosis. However, the comparison of pre- and post-operative plain CT images is considered to be useful in diagnosing lung torsion, and postoperative CT lung window setting sagittal images were examined in three cases of postoperative lung torsion. Results indicate that pulmonary torsion of the middle lobe after right lower lobectomy and the middle lobe after right upper lobectomy can be diagnosed by the present method.


Asunto(s)
Enfermedades Pulmonares , Neoplasias Pulmonares , Diagnóstico Precoz , Humanos , Pulmón/diagnóstico por imagen , Pulmón/cirugía , Enfermedades Pulmonares/diagnóstico por imagen , Enfermedades Pulmonares/cirugía , Neoplasias Pulmonares/diagnóstico por imagen , Neoplasias Pulmonares/cirugía , Neumonectomía , Tomografía Computarizada por Rayos X , Anomalía Torsional/diagnóstico por imagen , Anomalía Torsional/cirugía
7.
Kyobu Geka ; 74(4): 308-312, 2021 Apr.
Artículo en Japonés | MEDLINE | ID: mdl-33831892

RESUMEN

A 78-year-old man was admitted to our hospital for further examination of a mass shadow in the left lower lobe noted on chest computed tomography. Because lung cancer was suspected, a left lower lobectomy was performed. During surgery, the left lower lobe and heart were so tightly adherent that the pericardial defect was not initially perceivable. As we proceeded with adhesion detachment, we discovered that the left lower lobe and the myocardium were directly adherent to one another through a complete defect of the pericardium, which required very careful surgical technique. Because of the complete defect of the pericardium, we considered the risk of heart failure to be low and accordingly did not perform a repair. The postoperative course was uneventful.


Asunto(s)
Neoplasias Pulmonares , Pericardio , Anciano , Humanos , Pulmón , Neoplasias Pulmonares/diagnóstico por imagen , Neoplasias Pulmonares/cirugía , Masculino , Pericardio/diagnóstico por imagen , Pericardio/cirugía , Tomografía Computarizada por Rayos X
8.
Rev Col Bras Cir ; 48: e20202890, 2021.
Artículo en Inglés, Portugués | MEDLINE | ID: mdl-33852704

RESUMEN

OBJECTIVE: to report the preoperative localization of pulmonary nodules with the placement of a guidewire oriented by Computed Tomography. METHODS: the nodules were marked using a needle in the shape of a hook or another in the shape of a Q, guided by tomography. The choice of the location for the marking was the shortest distance from the chest wall to the nodule. The marking procedure was performed under local anesthesia and a tomographic control was obtained immediately at the end. Patients were referred to the operating room. Surgical resection occurred less than two hours after the needle placement. RESULTS: between February 2017 and October 2019, 22 patients aged 43 to 82 years (mean 62.1) were included. The nodules had diameters that varied from 4 to 30 mm and the distance between the nodules and the pleural surface varied from 2 to 43 mm. The location and resection of the nodules were successfully performed in all cases. The guidewire was displaced in five cases. Five patients presented pneumothorax, with the space between the visceral and parietal pleura varying from 2 to 19 mm. In nine patients, an intraparenchymal hematoma of 6 to 35 mm in length was observed without signs, symptoms, or hemodynamic and ventilatory repercussions. The histopathological study was conclusive in all patients. CONCLUSIONS: the localization of pulmonary nodules through guidewires proved to be safe, reliable, and feasible in this series of cases. There was no need for surgical intervention to treat complications.


Asunto(s)
Neoplasias Pulmonares , Nódulos Pulmonares Múltiples , Nódulo Pulmonar Solitario , Adulto , Anciano , Anciano de 80 o más Años , Humanos , Pulmón , Neoplasias Pulmonares/diagnóstico por imagen , Neoplasias Pulmonares/cirugía , Persona de Mediana Edad , Cuidados Preoperatorios , Estudios Retrospectivos , Cirugía Torácica Asistida por Video
9.
Sheng Wu Yi Xue Gong Cheng Xue Za Zhi ; 38(2): 399-404, 2021 Apr 25.
Artículo en Chino | MEDLINE | ID: mdl-33913302

RESUMEN

Because of the unobvious early symptoms and low 5-year survival rate, the early diagnosis and treatment is of great significance for patients with non-small cell lung cancer. Glucose transporter-1 is the most widely distributed glucose transporters in various tissue cells in the human body, whose expression in non-small cell lung cancer is closely related to the histological types, lymph node metastasis, degree of differentiation, progression and prognosis. 18F-FDG PET/CT imaging, a molecular imaging diagnostic method, is based on the characteristics of glucose metabolism in malignant tumors, which has been widely applied in the cancer diagnosis, stage division, evaluation of therapeutic effects and prognosis evaluation. Glucose transporter-1 is regulated and influenced by many factors, and it is closely related to 18F-FDG PET/CT imaging. This article briefly reviews the progress in the clinical application and correlation between glucose transporter-1 and 18F-FDG PET/CT imaging for non-small cell lung cancer, in order to improve the diagnosis and treatment of lung cancer.


Asunto(s)
Carcinoma de Pulmón de Células no Pequeñas , Neoplasias Pulmonares , Carcinoma de Pulmón de Células no Pequeñas/diagnóstico por imagen , Fluorodesoxiglucosa F18 , Proteínas Facilitadoras del Transporte de la Glucosa , Transportador de Glucosa de Tipo 1 , Humanos , Neoplasias Pulmonares/diagnóstico por imagen , Tomografía Computarizada por Tomografía de Emisión de Positrones , Tomografía de Emisión de Positrones , Radiofármacos
10.
Sensors (Basel) ; 21(8)2021 Apr 13.
Artículo en Inglés | MEDLINE | ID: mdl-33924549

RESUMEN

In order to develop appropriate treatment and rehabilitation plans with regard to different subpathological types (PILs and IAs) of lung nodules, it is important to diagnose them through low-dose spiral computed tomography (LDCT) during routine screening before surgery. Based on the characteristics of different subpathological lung nodules expressed from LDCT images, we propose a multi-dimension and multi-feature hybrid learning neural network in this paper. Our network consists of a 2D network part and a 3D network part. The feature vectors extracted from the 2D network and 3D network are further learned by XGBoost. Through this formation, the network can better integrate the feature information from the 2D and 3D networks. The main learning block of the network is a residual block combined with attention mechanism. This learning block enables the network to learn better from multiple features and pay more attention to the key feature map among all the feature maps in different channels. We conduct experiments on our dataset collected from a cooperating hospital. The results show that the accuracy, sensitivity and specificity of our network are 83%, 86%, 80%, respectively It is feasible to use this network to classify the subpathological type of lung nodule through routine screening.


Asunto(s)
Neoplasias Pulmonares , Tomografía Computarizada por Rayos X , Humanos , Pulmón/diagnóstico por imagen , Neoplasias Pulmonares/diagnóstico por imagen , Redes Neurales de la Computación , Tomografía Computarizada Espiral
13.
Clin Nucl Med ; 46(5): 424-426, 2021 May 01.
Artículo en Inglés | MEDLINE | ID: mdl-33782300

RESUMEN

ABSTRACT: A 50-year-old woman with a newly detected pulmonary ground-glass opacity (GGO) nodule underwent PET/CT to determine the likelihood of malignancy. This patient was enrolled in the prospective study (NCT04588064) to determine the effectiveness of 18F-FDG and 68Ga-FAPI PET/CT for characterization of the GGO nodule. On PET/CT images, minimal 18F-FDG uptake but intense 68Ga-FAPI uptake was observed in this GGO nodule. This patient subsequently underwent video-assisted thoracoscopic surgery, and postoperative pathological examination confirmed the diagnosis of invasive adenocarcinoma. This case presented an example where 68Ga-FAPI PET/CT showed higher tracer uptake than 18F-FDG in the malignant GGO nodule.


Asunto(s)
Fluorodesoxiglucosa F18 , Neoplasias Pulmonares/diagnóstico por imagen , Tomografía Computarizada por Tomografía de Emisión de Positrones , Quinolinas , Adenocarcinoma/diagnóstico por imagen , Adenocarcinoma/patología , Femenino , Humanos , Neoplasias Pulmonares/patología , Persona de Mediana Edad
14.
Zhongguo Yi Xue Ke Xue Yuan Xue Bao ; 43(1): 53-56, 2021 Feb 28.
Artículo en Chino | MEDLINE | ID: mdl-33663663

RESUMEN

Objective To compare the differences of energy spectrum CT between small cell lung cancer(SCLC)with mediastinal lymph node metastasis and mediastinal sarcoidosis.Methods Twenty-five SCLC patients with mediastinal lymph node metastasis(SCLC group)and 26 patients with mediastinal sarcoidosis(sarcoidosis group)confirmed by bronchoscopy and biopsy in Tangshan People's Hospital from January 2018 to June 2019 were selected as the research objects.The CT value,iodine concentration,water concentration and energy spectrum curve slope under different single energy levels were compared between SCLC group and sarcoidosis group.Results The single-energy CT values of 40-80 keV segments in the arterial phase of the SCLC group were significantly higher than those in the sarcoidosis group(all P <0.05).The single-energy CT values of 90-140 keV segments were not significantly different from those in the sarcoidosis group(all P >0.05).The single-energy CT values of 40-90 keV segments in venous phase of the SCLC group were significantly higher than those of the sarcoidosis group(all P <0.05),and the single-energy CT values of 100-140 keV segments were not significantly different from those of the sarcoidosis group(all P >0.05).The concentrations of iodine in the arterial phase and venous phase of the SCLC group were(11.56±4.06)µg/cm 3 and(13.39±0.87)µg/cm 3,respectively,which were significantly higher than those [(4.43±3.85)µg/cm 3,t=11.564,P=0.026;(7.23±2.71)µg/cm 3,t=13.653,P=0.021] in the sarcoidosis group.The concentrations of water in the arterial and venous phases of the SCLC group were(1040.67±5.62)mg/cm 3 and(1035.23±8.57)mg/cm 3,respectively,which showed no statistically significant difference compared with those [(1028.87±6.94)mg/cm 3,t=3.155,P=1.861;(1021.53±4.68)mg/cm 3,t=3.265,P=1.687] in the sarcoidosis group.The slopes of energy spectrum curve at 40-70 keV,70-100 keV and 100-140 keV in venous phase of the SCLC group were significantly higher than those of the sarcoidosis group(all P <0.05),whereas they showed no significant difference between the two groups in arterial phase(all P >0.05).Conclusion The differences between SCLC with mediastinal lymph node metastasis and mediastinal sarcoidosis can be shown on the single-energy CT values of 40-80 keV in arterial phase and 40-90 keV in venous phase,iodine concentrations in arterial phase and venous phase,and the slope of energy spectrum curve in venous phase.


Asunto(s)
Neoplasias Pulmonares , Sarcoidosis , Carcinoma Pulmonar de Células Pequeñas , Humanos , Neoplasias Pulmonares/diagnóstico por imagen , Ganglios Linfáticos , Metástasis Linfática , Sarcoidosis/diagnóstico por imagen , Carcinoma Pulmonar de Células Pequeñas/diagnóstico por imagen , Tomografía Computarizada por Rayos X
15.
Cancer Invest ; 39(4): 321-332, 2021 Apr.
Artículo en Inglés | MEDLINE | ID: mdl-33645376

RESUMEN

BACKGROUND: The detection rate of lung nodules has increased significantly among petroleum workers in North China since the low-dose CT (LDCT) screening has been widely carried out. What's more, the number of confirmed early lung cancers is increasing continuously. Therefore, a great deal of concern for the high risk of lung cancer has been shown among petroleum workers. PURPOSE: To improve the screening efficiency and maximize the benefits of the subjects, the current situation of LDCT lung cancer screening should be understood and the imaging characteristics of early lung cancer should be analyzed for petroleum workers in North China. MATERIALS AND METHODS: Firstly, the dynamic changes of LDCT early lung cancer screening for petroleum workers in North China were analyzed in recent years. Then, the survey data of 3121 petroleum workers was compared with that of 1868 non-petroleum workers, which was analyzed. Finally, 91 patients (129 nodular lung cancer) confirmed by pathology were retrospectively analyzed, and the data of which was compared with the clinical features obtained from survey data above. The imaging characteristics and related factors of different subtypes of lung adenocarcinoma were discussed and analyzed. RESULTS: Lung nodules were found in 810 cases (25.95%) out of 3121 petroleum workers; and the surgery was chosen by 42 patients, 38 of whom were confirmed as lung cancer. Compared with the data of screened petroleum workers, there were more older people and more females as well as a higher proportion of people with family malignancy history, and a lower proportion of smoking people in 91 patients with lung cancer. As the pathological grade of tumor nodules increased, the volume and diameter of nodules gradually increased, and the mean density, maximum density and standard deviation of density also increased (p < 0.001). The volume and diameter of nodules were positively correlated with ages (p < 0.05). CONCLUSION: The occurrence of lung adenocarcinoma is closely related to the family history of malignant tumors, and the constituent ratio of young women without a history of smoking increased significantly. At the same time, the quantitative information obtained by using CT images has important value in predicting its pathological subtypes.


Asunto(s)
Adenocarcinoma del Pulmón/diagnóstico por imagen , Detección Precoz del Cáncer , Neoplasias Pulmonares/diagnóstico por imagen , Nódulos Pulmonares Múltiples/diagnóstico por imagen , Enfermedades Profesionales/diagnóstico por imagen , Salud Laboral , Industria del Petróleo y Gas , Nódulo Pulmonar Solitario/diagnóstico por imagen , Tomografía Computarizada por Rayos X , Adenocarcinoma del Pulmón/etiología , Adenocarcinoma del Pulmón/patología , Adenocarcinoma del Pulmón/cirugía , Adulto , Biopsia , China , Femenino , Encuestas Epidemiológicas , Humanos , Neoplasias Pulmonares/etiología , Neoplasias Pulmonares/patología , Neoplasias Pulmonares/cirugía , Masculino , Persona de Mediana Edad , Nódulos Pulmonares Múltiples/etiología , Nódulos Pulmonares Múltiples/patología , Nódulos Pulmonares Múltiples/cirugía , Clasificación del Tumor , Enfermedades Profesionales/etiología , Enfermedades Profesionales/patología , Enfermedades Profesionales/cirugía , Valor Predictivo de las Pruebas , Estudios Retrospectivos , Medición de Riesgo , Factores de Riesgo , Nódulo Pulmonar Solitario/etiología , Nódulo Pulmonar Solitario/patología , Nódulo Pulmonar Solitario/cirugía , Carga Tumoral
16.
J Comput Assist Tomogr ; 45(2): 330-336, 2021.
Artículo en Inglés | MEDLINE | ID: mdl-33661151

RESUMEN

OBJECTIVE: The aim of the study was to evaluate computed tomography (CT) findings of pulmonary NUT midline carcinoma. METHODS: We assessed clinical and CT features of pulmonary NUT carcinoma in 10 consecutive patients (M:F, 7:3; mean, 39 years). RESULTS: The primary tumors (size range, 15-65 mm) manifested as either a peripheral tumor (5/10) or a central tumor (5/10). All tumors showed relatively low-attenuation at contrast-enhanced CT (mean net enhancement, 26 HU). Associated CT findings were metastatic hilar or mediastinal lymphadenopathy (8/10), ipsilateral pleural seeding with malignant pleural effusion (2/10), and distant metastasis (2/10). Five patients with low tumor-node-metastasis stages after optimal treatment showed no evidence of disease (50%) for 6 to 35 months. CONCLUSIONS: Pulmonary NUT carcinoma presented as a peripheral or a central lung mass showing mild degree of contrast enhancement, frequent metastatic regional lymphadenopathy, affecting relatively young adults. Although known to be highly aggressive, an early diagnosis in low TNM stages can lead to a favorable prognosis.


Asunto(s)
Carcinoma de Células Escamosas/diagnóstico por imagen , Carcinoma de Células Escamosas/patología , Neoplasias Pulmonares/diagnóstico por imagen , Neoplasias Pulmonares/patología , Adolescente , Adulto , Carcinoma de Células Escamosas/terapia , Femenino , Humanos , Pulmón/diagnóstico por imagen , Pulmón/patología , Neoplasias Pulmonares/terapia , Masculino , Persona de Mediana Edad , Tomografía Computarizada por Tomografía de Emisión de Positrones , Estudios Retrospectivos , Tomografía Computarizada por Rayos X
18.
JAMA ; 325(10): 971-987, 2021 03 09.
Artículo en Inglés | MEDLINE | ID: mdl-33687468

RESUMEN

Importance: Lung cancer is the leading cause of cancer-related death in the US. Objective: To review the evidence on screening for lung cancer with low-dose computed tomography (LDCT) to inform the US Preventive Services Task Force (USPSTF). Data Sources: MEDLINE, Cochrane Library, and trial registries through May 2019; references; experts; and literature surveillance through November 20, 2020. Study Selection: English-language studies of screening with LDCT, accuracy of LDCT, risk prediction models, or treatment for early-stage lung cancer. Data Extraction and Synthesis: Dual review of abstracts, full-text articles, and study quality; qualitative synthesis of findings. Data were not pooled because of heterogeneity of populations and screening protocols. Main Outcomes and Measures: Lung cancer incidence, lung cancer mortality, all-cause mortality, test accuracy, and harms. Results: This review included 223 publications. Seven randomized clinical trials (RCTs) (N = 86 486) evaluated lung cancer screening with LDCT; the National Lung Screening Trial (NLST, N = 53 454) and Nederlands-Leuvens Longkanker Screenings Onderzoek (NELSON, N = 15 792) were the largest RCTs. Participants were more likely to benefit than the US screening-eligible population (eg, based on life expectancy). The NLST found a reduction in lung cancer mortality (incidence rate ratio [IRR], 0.85 [95% CI, 0.75-0.96]; number needed to screen [NNS] to prevent 1 lung cancer death, 323 over 6.5 years of follow-up) with 3 rounds of annual LDCT screening compared with chest radiograph for high-risk current and former smokers aged 55 to 74 years. NELSON found a reduction in lung cancer mortality (IRR, 0.75 [95% CI, 0.61-0.90]; NNS to prevent 1 lung cancer death of 130 over 10 years of follow-up) with 4 rounds of LDCT screening with increasing intervals compared with no screening for high-risk current and former smokers aged 50 to 74 years. Harms of screening included radiation-induced cancer, false-positive results leading to unnecessary tests and invasive procedures, overdiagnosis, incidental findings, and increases in distress. For every 1000 persons screened in the NLST, false-positive results led to 17 invasive procedures (number needed to harm, 59) and fewer than 1 person having a major complication. Overdiagnosis estimates varied greatly (0%-67% chance that a lung cancer was overdiagnosed). Incidental findings were common, and estimates varied widely (4.4%-40.7% of persons screened). Conclusions and Relevance: Screening high-risk persons with LDCT can reduce lung cancer mortality but also causes false-positive results leading to unnecessary tests and invasive procedures, overdiagnosis, incidental findings, increases in distress, and, rarely, radiation-induced cancers. Most studies reviewed did not use current nodule evaluation protocols, which might reduce false-positive results and invasive procedures for false-positive results.


Asunto(s)
Detección Precoz del Cáncer , Neoplasias Pulmonares/diagnóstico por imagen , Tomografía Computarizada por Rayos X , Anciano , Anciano de 80 o más Años , Causas de Muerte , Detección Precoz del Cáncer/efectos adversos , Reacciones Falso Positivas , Humanos , Pulmón/diagnóstico por imagen , Neoplasias Pulmonares/epidemiología , Neoplasias Pulmonares/mortalidad , Uso Excesivo de los Servicios de Salud , Persona de Mediana Edad , Guías de Práctica Clínica como Asunto , Factores de Riesgo , Sensibilidad y Especificidad , Fumar/efectos adversos , Procedimientos Innecesarios
19.
JAMA ; 325(10): 988-997, 2021 03 09.
Artículo en Inglés | MEDLINE | ID: mdl-33687469

RESUMEN

Importance: The US Preventive Services Task Force (USPSTF) is updating its 2013 lung cancer screening guidelines, which recommend annual screening for adults aged 55 through 80 years who have a smoking history of at least 30 pack-years and currently smoke or have quit within the past 15 years. Objective: To inform the USPSTF guidelines by estimating the benefits and harms associated with various low-dose computed tomography (LDCT) screening strategies. Design, Setting, and Participants: Comparative simulation modeling with 4 lung cancer natural history models for individuals from the 1950 and 1960 US birth cohorts who were followed up from aged 45 through 90 years. Exposures: Screening with varying starting ages, stopping ages, and screening frequency. Eligibility criteria based on age, cumulative pack-years, and years since quitting smoking (risk factor-based) or on age and individual lung cancer risk estimation using risk prediction models with varying eligibility thresholds (risk model-based). A total of 1092 LDCT screening strategies were modeled. Full uptake and adherence were assumed for all scenarios. Main Outcomes and Measures: Estimated lung cancer deaths averted and life-years gained (benefits) compared with no screening. Estimated lifetime number of LDCT screenings, false-positive results, biopsies, overdiagnosed cases, and radiation-related lung cancer deaths (harms). Results: Efficient screening programs estimated to yield the most benefits for a given number of screenings were identified. Most of the efficient risk factor-based strategies started screening at aged 50 or 55 years and stopped at aged 80 years. The 2013 USPSTF-recommended criteria were not among the efficient strategies for the 1960 US birth cohort. Annual strategies with a minimum criterion of 20 pack-years of smoking were efficient and, compared with the 2013 USPSTF-recommended criteria, were estimated to increase screening eligibility (20.6%-23.6% vs 14.1% of the population ever eligible), lung cancer deaths averted (469-558 per 100 000 vs 381 per 100 000), and life-years gained (6018-7596 per 100 000 vs 4882 per 100 000). However, these strategies were estimated to result in more false-positive test results (1.9-2.5 per person screened vs 1.9 per person screened with the USPSTF strategy), overdiagnosed lung cancer cases (83-94 per 100 000 vs 69 per 100 000), and radiation-related lung cancer deaths (29.0-42.5 per 100 000 vs 20.6 per 100 000). Risk model-based vs risk factor-based strategies were estimated to be associated with more benefits and fewer radiation-related deaths but more overdiagnosed cases. Conclusions and Relevance: Microsimulation modeling studies suggested that LDCT screening for lung cancer compared with no screening may increase lung cancer deaths averted and life-years gained when optimally targeted and implemented. Screening individuals at aged 50 or 55 years through aged 80 years with 20 pack-years or more of smoking exposure was estimated to result in more benefits than the 2013 USPSTF-recommended criteria and less disparity in screening eligibility by sex and race/ethnicity.


Asunto(s)
Detección Precoz del Cáncer , Neoplasias Pulmonares/diagnóstico por imagen , Guías de Práctica Clínica como Asunto , Tomografía Computarizada por Rayos X , Anciano , Detección Precoz del Cáncer/efectos adversos , Detección Precoz del Cáncer/normas , Humanos , Pulmón/diagnóstico por imagen , Neoplasias Pulmonares/mortalidad , Neoplasias Pulmonares/prevención & control , Persona de Mediana Edad , Modelos Teóricos , Medición de Riesgo , Sensibilidad y Especificidad , Fumar , Cese del Hábito de Fumar , Tomografía Computarizada por Rayos X/efectos adversos , Tomografía Computarizada por Rayos X/métodos
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