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1.
Anticancer Res ; 40(8): 4401-4404, 2020 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-32727769

RESUMO

BACKGROUND: The occurrence of lung adenocarcinoma metastasizing to the pancreas is overall rare and can histologically imitate primary pancreatic ductal carcinoma (PDAC). CASE REPORT: This is a case report of a 70-year-old female with a history of surgically resected right lung adenocarcinoma presenting for routine follow up without symptoms. CT scans revealed a pancreatic cystic mass with ductal dilatation that was sampled via endoscopic ultrasound-guided fine needle aspiration (EUS-FNA) and thought to be a primary pancreatic mucinous neoplasm with high grade dysplasia suspicious for carcinoma based on smear cytology. On repeat EUS-FNA and biopsy (FNB) with additional immunohistochemical testing for lung adenocarcinoma markers thyroid transcription factor (TTF1) and Napsin A and molecular testing, the lesion was identified as a metastasis of lung adenocarcinoma with an epidermal growth factor receptor (EGFR L858R) mutation; subsequently, the patient underwent targeted therapy that yielded an almost complete response. CONCLUSION: To the best of our knowledge, this is the first documented case in English literature of a lung adenocarcinoma metastasis to the pancreas mimicking a pancreatic primary neoplasm and highlights the potential pitfalls of EUS-FNA for the diagnosis of certain metastases to the pancreas.


Assuntos
Adenocarcinoma de Pulmão/diagnóstico por imagem , Neoplasias Pulmonares/diagnóstico por imagem , Neoplasias Pancreáticas/secundário , Adenocarcinoma de Pulmão/genética , Adenocarcinoma de Pulmão/metabolismo , Adenocarcinoma de Pulmão/patologia , Idoso , Biomarcadores/metabolismo , Carcinoma Ductal Pancreático/diagnóstico por imagem , Carcinoma Ductal Pancreático/genética , Carcinoma Ductal Pancreático/metabolismo , Carcinoma Ductal Pancreático/patologia , Diagnóstico Diferencial , Aspiração por Agulha Fina Guiada por Ultrassom Endoscópico , Receptores ErbB/genética , Feminino , Humanos , Neoplasias Pulmonares/genética , Neoplasias Pulmonares/metabolismo , Neoplasias Pulmonares/patologia , Mutação , Neoplasias Pancreáticas/genética , Neoplasias Pancreáticas/metabolismo , Neoplasias Pancreáticas/patologia , Tomografia Computadorizada por Raios X
2.
Zhonghua Zhong Liu Za Zhi ; 42(6): 449-455, 2020 Jun 23.
Artigo em Chinês | MEDLINE | ID: mdl-32575939

RESUMO

Objective: To investigate the high resolution CT (HRCT) features of lung adenocarcinoma for differentiating synchronous multiple lung adenocarcinoma from lung adenocarcinoma with intrapulmonary metastasis. Methods: The clinical and imaging features of 131 lesions from 62 patients of synchronous multiple primary lung adenocarcinoma (primary group) and 67 lesions from 31 patients of lung adenocarcinoma with intrapulmonary metastases (metastasis group) were retrospectively analyzed. According to the types of lesion, including pure ground glass nodule (pGGN), mixed ground glass nodule (mGGN) and solid nodule (SN), the image feature matching types of patients were divided into 7 types. The differences of image feature matching types between the primary group and the metastasis group were compared. Multiple lesions in the lung of patients were classified into the main lesion and the concomitant lesions according to their size. The differences including the size of the main lesion and the concomitant lesion (long diameter of nodule, long diameter of solid component in nodule), whether it contains ground glass components in nodule, shape, lobulation, margin, spiculation, bubble-like lucency, pleural retraction and pleural attachment were recorded and analyzed. The differences of image features of main lesion and the concomitant lesion in the primary group and the metastasis group were compared. Results: The image feature matching types of pGGN + mGGN and mGGN + mGGN were more common in the primary group, and the ground glass component contained pGGN or mGGN was accounted for 62.9%(39/62). At least one lesion containing the ground glass component was accounted for 96.8% (60/62). There were two types in metastatic groups, mGGN+ SN and SN+ SN accounting for 6.5% (2/31) and 93.5% (29/31), respectively. There were significant differences in image feature matching types between the primary group and metastatic group (P<0.01). Univariate analysis of the main lesions between the two groups showed that the gender, smoking history, long diameter of the main lesion, long diameter of the solid component, the ground glass component and pleural attachment were statistically different (P<0.05). Further analysis by multivariate logistic regression showed that the male (OR=5.742, P=0.010), SN (OR=41.291, P<0.01) and pleural attachment (OR=9.288, P=0.001) were the three significant risk factors associated with the main lesions in metastasis group.The most common concomitant lesions in primary group were pGGN, containing the ground glass component. However, all of the concomitant lesions in the metastatic group were SN (P<0.01), showing round lesions with well-defined margin, attaching the pleura (P<0.05). Conclusions: The HRCT features of lung adenocarcinoma can differentiate synchronous multiple lung adenocarcinoma from lung adenocarcinoma with intrapulmonary metastasis. At least one lesion contains ground glass components (pGGN or mGGN) in synchronous multiple primary lung adenocarcinoma, while SN is more common in lung adenocarcinoma with lung metastasis. Lung cancer with intrapulmonary metastasis can be considered when the main lesion is SN with pleural attachment and the intrapulmonary accompanying lesion is also solid nodules without lobular, speculation and bubble-like lucency.


Assuntos
Adenocarcinoma de Pulmão/diagnóstico por imagem , Neoplasias Pulmonares/diagnóstico por imagem , Neoplasias Pulmonares/patologia , Nódulos Pulmonares Múltiplos/diagnóstico por imagem , Nódulos Pulmonares Múltiplos/patologia , Neoplasias Primárias Múltiplas/diagnóstico por imagem , Tomografia Computadorizada por Raios X/métodos , Adenocarcinoma , Humanos , Pulmão/diagnóstico por imagem , Pulmão/patologia , Masculino , Invasividade Neoplásica , Interpretação de Imagem Radiográfica Assistida por Computador , Estudos Retrospectivos
3.
Medicine (Baltimore) ; 99(26): e20594, 2020 Jun 26.
Artigo em Inglês | MEDLINE | ID: mdl-32590735

RESUMO

The recently published 8th edition of the tumor node and metastasis Classification of Lung Cancer proposes using the maximum dimension of the solid component of a ground glass nodule (GGN) for the T categorization. However, few studies have investigated the collection of this information when using mediastinal window settings. In this study, we evaluated tumor measurement data obtained from computed tomography (CT) scans when using mediastinal window settings.This study included 202 selected patients with persistent, partly solid GGNs detected on thin-slice CT after surgical treatment between 2004 and 2013. We compared the differences in tumor diameters measured by 2 different radiologists using a repeated-measures analysis of variance. We divided the patients into 2 groups based on the clinical T stage (T1a+T1b vs T1c) and estimated the probability of overall survival (OS) and disease-free survival (DFS) using Kaplan-Meier curves.The study included 94 male and 108 female patients. The inter-reviewer differences between tumor diameters were significantly smaller when the consolidation to maximum tumor diameter ratio was ≤0.5. The 2 clinical groups classified by clinical T stage differed significantly with respect to DFS when using the mediastinal window settings. However, no significant differences in OS or DFS were observed when using the lung window setting.Our study yielded 2 major findings. First, the diameters of GGNs could be measured more accurately using the mediastinal window setting. Second, measurements obtained using the mediastinal window setting more clearly depicted the effect of clinical T stage on DFS.


Assuntos
Adenocarcinoma de Pulmão/diagnóstico por imagem , Neoplasias Pulmonares/diagnóstico por imagem , Tomografia Computadorizada por Raios X/métodos , Adenocarcinoma de Pulmão/mortalidade , Adenocarcinoma de Pulmão/patologia , Idoso , Intervalo Livre de Doença , Feminino , Humanos , Neoplasias Pulmonares/mortalidade , Neoplasias Pulmonares/patologia , Masculino , Invasividade Neoplásica , Estudos Retrospectivos
4.
Hosp. domic ; 4(2): 39-44, abr.-jun. 2020.
Artigo em Espanhol | IBECS | ID: ibc-193389

RESUMO

Presentamos el caso de un paciente varón de 67 años diagnosticado de adenocarcinoma de pulmón en estadio IV con dolor irruptivo oncológico (DIO) de difícil control. Durante el transcurso de la enfermedad el paciente necesitó varios ingresos por complicaciones, siendo la más común el mal control del DIO. Tras varios cambios en la pauta analgésica (rotación de opioides, cambios en tratamientos coadyuvantes y vías de administración), se consiguió buen control del dolor a pesar de progresión de la enfermedad de base. Finalmente, el paciente precisó ingreso hospitalario ante deterioro del estado general y claudicación familiar. Ante mal pronóstico, el equipo de Cuidados Paliativos y los familiares decidieron instaurar tratamiento con medidas de confort. De la relevancia del caso clínico que aportamos se concluye que es necesaria la existencia de equipos multidisciplinares formados y entrenados en este ámbito para un buen manejo terapéutico y una mejor calidad de vida en los pacientes


We present the case of a 67-year-old male with stage IV adenocarcinoma lung cancer who presented difficult control of breakthrough cancer pain. During the course of the disease, the patient had to be hospitalized several times due to complications. The most common complication was breakthrough cancer pain. After many changes in the analgesic treatment (opioid rotation, changes in coadjuvant drugs and routes of administration), good control of analgesic pain was achieved despite the progression of this underlying disease. Finally, the patient required being hospitalized due to deterioration of the general condition and family claudication. Faced with a por prognosis, the Palliative Care and Oncology team decided to establish treatment with comfort measures. We can conclude that the existence of multidisciplinary trained team is necessary for good therapeutic management and a better quality of life in patients


Assuntos
Humanos , Masculino , Idoso , Adenocarcinoma de Pulmão/patologia , Neoplasias Pulmonares/patologia , Dor do Câncer/tratamento farmacológico , Dor Irruptiva/tratamento farmacológico , Neoplasias das Glândulas Suprarrenais/secundário , Neoplasias das Glândulas Suprarrenais/diagnóstico por imagem , Adenocarcinoma de Pulmão/diagnóstico por imagem , Neoplasias Pulmonares/diagnóstico por imagem , Estadiamento de Neoplasias
6.
Tumori ; 106(4): 312-318, 2020 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-32326835

RESUMO

OBJECTIVE: To determine the effect of systemic inflammation indexes and fluorine-18 fluorodeoxyglucose (18FDG) positron emission tomography (PET) metabolic parameters on survival in advanced lung adenocarcinoma. METHODS: A total of 133 patients who underwent 18FDG PET for initial staging were investigated retrospectively. Baseline patient characteristics, routine blood test results, 18FDG PET metabolic parameters, and treatment history were examined. Overall survival (OS) was demonstrated by Kaplan-Meier analysis, and the curves were compared by the log-rank test. Systemic inflammation response index (SIRI) was defined as neutrophil x monocyte/lymphocyte count. RESULTS: Lymphocyte/monocyte ratio (LMR) and SIRI were found to be significant for OS. The cutoff point was 2.25 for LMR. Median OS was 8 months for ⩽2.25 and 14 months for >2.25 (p = 0.005). For SIRI, the cutoff point was 2. SIRI ⩽2 was associated with a median OS of 16 months compared to 10 months for patients with SIRI >2 (p = 0.043). Maximum of standardized uptake value, total lesion glycolysis, and metabolic tumor volume were not found to be significant for OS (p = 0.225, p = 0.061, p = 0.355, respectively). No correlation was found between inflammatory indexes and PET metabolic parameters. CONCLUSION: Age and LMR parameters were prognostic for survival in Cox regression analysis. There was no correlation between 18FDG PET parameters and inflammatory indexes.


Assuntos
Adenocarcinoma de Pulmão/metabolismo , Linfócitos/metabolismo , Monócitos/metabolismo , Síndrome de Resposta Inflamatória Sistêmica/metabolismo , Adenocarcinoma de Pulmão/complicações , Adenocarcinoma de Pulmão/diagnóstico por imagem , Adenocarcinoma de Pulmão/patologia , Idoso , Feminino , Fluordesoxiglucose F18/administração & dosagem , Humanos , Estimativa de Kaplan-Meier , Linfócitos/patologia , Masculino , Pessoa de Meia-Idade , Monócitos/patologia , Tomografia por Emissão de Pósitrons , Prognóstico , Estudos Retrospectivos , Síndrome de Resposta Inflamatória Sistêmica/complicações , Síndrome de Resposta Inflamatória Sistêmica/diagnóstico por imagem , Síndrome de Resposta Inflamatória Sistêmica/patologia , Carga Tumoral
7.
Asian Cardiovasc Thorac Ann ; 28(4): 216-218, 2020 May.
Artigo em Inglês | MEDLINE | ID: mdl-32276540

RESUMO

There are limited data on the surgical management of localized and residual diseases in patients with stage IV non-small-cell lung cancer that was treated with nivolumab. Herein, we present two patients who underwent salvage thoracoscopic resection for residual diseases (left lower lobectomy and paratracheal lymph node resection, respectively) after chemotherapy and immunotherapy for stage IV adenocarcinoma. The indications, intraoperative findings, and histopathological findings are discussed in this report.


Assuntos
Adenocarcinoma de Pulmão/terapia , Antineoplásicos Imunológicos/uso terapêutico , Carcinoma Pulmonar de Células não Pequenas/terapia , Neoplasias Pulmonares/terapia , Excisão de Linfonodo , Nivolumabe/uso terapêutico , Pneumonectomia , Terapia de Salvação , Cirurgia Torácica Vídeoassistida , Adenocarcinoma de Pulmão/diagnóstico por imagem , Adenocarcinoma de Pulmão/secundário , Idoso , Carcinoma Pulmonar de Células não Pequenas/diagnóstico por imagem , Carcinoma Pulmonar de Células não Pequenas/secundário , Feminino , Humanos , Neoplasias Pulmonares/diagnóstico por imagem , Neoplasias Pulmonares/patologia , Masculino , Estadiamento de Neoplasias , Resultado do Tratamento
8.
Int J Clin Oncol ; 25(6): 1079-1089, 2020 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-32130543

RESUMO

BACKGROUND: pStage I includes clinicopathologically diverse groups. This study aimed to identify the prognostic factors for pStage I lung adenocarcinoma. METHODS: We retrospectively reviewed 208 patients with pStage I adenocarcinomas who underwent curative resection in our institute between 2006 and 2013. The maximum standardized uptake value (SUVmax) on [F18]-fluoro-deoxy-D-glucose positron emission tomography-computed tomography (PET/CT) was evaluated. Adenocarcinomas were categorized into the following histologic groups: group 0 (minimally invasive adenocarcinoma and lepidic predominant adenocarcinoma), group 1 (papillary predominant adenocarcinoma), and group 2 (acinar predominant adenocarcinoma and all the remaining subtypes). We assessed the relationship between disease-free survival (DFS) and clinicopathological factors. RESULTS: Multivariate analysis of DFS demonstrated that SUVmax > 3.0 (p < 0.001), total tumor size > 20 mm (p = 0.016), and histologic groups (p < 0.05) were independent prognostic factors. The prognostic risk score (PRS) was calculated using the following equation: PRS = SUVmax (≤ 3.0: 0 point, > 3.0: 2 points) + total tumor size (≤ 20 mm: 0 point, > 20 mm: 1 point) + histologic group (group 0: 0 point, group 1: 1 point, group 2: 2 points). Patients were divided into the following three risk groups: low-risk (PRS 0-2 points, n = 136), intermediate-risk (PRS 3-4 points, n = 49), and high-risk groups (PRS 5 points, n = 13). The 5-year DFS rates were 93.2%, 50.6%, and 30.8% for the low-, intermediate-, and high-risk groups, respectively (p < 0.001). CONCLUSIONS: The PRS aggregating the FDG-PET/CT SUVmax, total tumor size, and histologic group predicts the prognosis of pStage I lung adenocarcinoma.


Assuntos
Adenocarcinoma de Pulmão/diagnóstico por imagem , Adenocarcinoma de Pulmão/patologia , Neoplasias Pulmonares/diagnóstico por imagem , Neoplasias Pulmonares/patologia , Adenocarcinoma de Pulmão/mortalidade , Adenocarcinoma de Pulmão/cirurgia , Idoso , Intervalo Livre de Doença , Feminino , Fluordesoxiglucose F18/farmacocinética , Humanos , Neoplasias Pulmonares/mortalidade , Neoplasias Pulmonares/cirurgia , Masculino , Pessoa de Meia-Idade , Tomografia Computadorizada com Tomografia por Emissão de Pósitrons , Prognóstico , Compostos Radiofarmacêuticos/farmacocinética , Estudos Retrospectivos , Fatores de Risco , Carga Tumoral
9.
Clin Nucl Med ; 45(6): 468-470, 2020 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-32149789

RESUMO

A 71-year-old man with pathologically confirmed rectal cancer underwent F-FDG PET/CT before radical operation, which showed multiple nodules with low uptake in bilateral pleura and 1 solitary pulmonary nodule with slight uptake in left lung. The subpleural nodule was diagnosed as benign lesion through the biopsy. Ga-labeled fibroblast-activation-protein inhibitor PET/CT was performed for further evaluation, which showed low uptake in bilateral subpleural nodules but focally increased uptake in the nodule of left lung. This nodule was found to be a primary lung adenocarcinoma by the CT-guided biopsy. A diagnosis of rectum and lung double primary malignancies was finally made.


Assuntos
Segunda Neoplasia Primária/diagnóstico por imagem , Tomografia Computadorizada com Tomografia por Emissão de Pósitrons , Quinolinas , Neoplasias Retais/diagnóstico por imagem , Adenocarcinoma de Pulmão/diagnóstico por imagem , Idoso , Biópsia , Humanos , Masculino , Segunda Neoplasia Primária/patologia
10.
Can Assoc Radiol J ; 71(2): 208-216, 2020 May.
Artigo em Inglês | MEDLINE | ID: mdl-32062999

RESUMO

PURPOSE: To identify computed tomography (CT) features of epidermal growth factor receptor (EGFR) mutation-positive lung adenocarcinoma in Canadian population and whether imaging-based surrogate markers of EGFR mutation in our population were similar to those found in the Asian population. MATERIALS AND METHODS: Pretreatment CT scans of 223 patients with adenocarcinoma of the lung (112 with EGFR mutation and 111 without mutation) were retrospectively assessed for 20 specific CT features by 2 radiologists, who were blinded to the status of EGFR mutation. Univariate and multivariate logistic regression analyses as well as areas under the receiver operating characteristic curve were performed to discriminate characteristics of EGFR-activating mutation features. RESULTS: Epidermal growth factor receptor mutation-positive adenocarcinomas were more frequently found in female (P < .03), less than 20 pack-year smoking history (P < .001), smaller tumor (P < .01), spiculated margins (P < .05), without centrilobular emphysema (P < .001), and without lymphadenopathy (P < .05), similarly to the Asian population. Multivariate logistic regression analyses of combined clinical and radiological features identified less than 20 pack-year smoking history, smaller tumor diameter, fine or coarse spiculations, noncentral location of the tumor, and lack of centrilobular emphysema and pleural attachment as the strongest independent prognostic factors for the presence of an EGFR mutation. These combined features improved prognostic ability area under the curve to 0.879, compared to 0.788 for clinical features only. CONCLUSION: Several CT findings may help predict the presence of an activating mutation in EGFR in lung adenocarcinomas in our Canadian population. Combining clinical and radiological features improves prognostic ability to determine the EGFR mutation status compared to clinical features alone.


Assuntos
Adenocarcinoma de Pulmão/diagnóstico por imagem , Adenocarcinoma de Pulmão/genética , Neoplasias Pulmonares/diagnóstico por imagem , Neoplasias Pulmonares/genética , Adenocarcinoma de Pulmão/patologia , Idoso , Área Sob a Curva , Grupo com Ancestrais do Continente Asiático , Biomarcadores Tumorais/genética , Canadá/etnologia , Receptores ErbB/genética , Grupo com Ancestrais do Continente Europeu , Feminino , Humanos , Neoplasias Pulmonares/patologia , Masculino , Pessoa de Meia-Idade , Tomografia Computadorizada Multidetectores , Mutação , Prognóstico , Enfisema Pulmonar/diagnóstico por imagem , Curva ROC , Estudos Retrospectivos , Método Simples-Cego , Fumar , Carga Tumoral
11.
Ann Thorac Surg ; 109(6): 1722-1730, 2020 06.
Artigo em Inglês | MEDLINE | ID: mdl-32057816

RESUMO

BACKGROUND: We aimed to clarify clinical profiles of patients with adenocarcinoma presenting as multifocal ground-glass opacities (MGGOs) to assess their prognosis and the optimal management method for residual satellite lesions. METHODS: We identified 190 patients with cN0 MGGOs (MGGO cohort) and 1426 patients with solitary lung adenocarcinoma (control cohort) who underwent complete resection between 2004 and 2016. Propensity score matching was performed to adjust for differences in baseline characteristics of both cohorts for survival analyses. MGGOs consist of a main tumor and satellite lesions and were subdivided into 3 groups: the PG group, with multifocal pure GGOs; the GD group, in which the main tumor presented as GGO dominant; and the SD group, where the main tumor presented as solid dominant. RESULTS: No significant differences in recurrence-free survival were observed between the 2 cohorts before and after the propensity score matching. For patients with MGGOs, 22 were in the PG group, 47 in the GD group, and 121 in the SD group. Type of MGGOs was a significant factor for recurrence-free survival recurrence-free survival both in the entire population (SD vs PG-GD, P = .008) and in p-stage I cohorts (P = .004) on multivariable analysis. Among 116 patients (61.1%) with residual satellite lesions, 38 patients had progressed lesions and 69 stable lesions. Although the emergence of new lesions during the follow-up period was an independent predictor for satellite lesion progression, neither progressed lesions nor the emergence of new lesions influenced survival. CONCLUSIONS: Patients with MGGOs and solitary adenocarcinoma had a similar prognosis. The biologic behavior of main tumors dominates clinical outcomes in patients with MGGOs.


Assuntos
Adenocarcinoma de Pulmão/diagnóstico por imagem , Tomografia Computadorizada por Raios X , Adenocarcinoma de Pulmão/patologia , Adenocarcinoma de Pulmão/terapia , Adulto , Idoso , Idoso de 80 Anos ou mais , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Prognóstico , Estudos Retrospectivos , Análise de Sobrevida , Adulto Jovem
12.
Medicine (Baltimore) ; 99(2): e18678, 2020 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-31914061

RESUMO

To investigate the correlation between the proliferating cell nuclear antigen Ki-67 and the multislice computed tomography (MSCT) signs in different subtypes of lung adenocarcinoma.Ninety-five patients with lung adenocarcinoma confirmed by surgical pathology and treated between January 2017 and December 2017 were included. MSCT was performed before the operation, and the characteristics of the high-resolution CT (HRCT) signs of the lesions were compared with the Ki-67 immunohistochemistry results.The levels of Ki-67 in the 95 lung adenocarcinoma specimens were positively correlated with the malignancy of lung adenocarcinoma. Spearman correlation coefficient was 0.615. The expression of Ki-67 was positively correlated with the nodules' diameter, density, and lobulated sign, with Spearman correlation coefficients of 0.58, 0.554, and 0.436. There was no significant correlation with spiculation and pleural retraction, with correlation coefficients of 0.319/0.381.These findings suggest that the MSCT signs of different types of lung adenocarcinoma might be associated with the expression of Ki-67. Without replacing biopsy, the imaging features of pulmonary nodules could be comprehensively analyzed to evaluate the proliferation potential of preoperative nodules, but additional studies are needed for confirmation.


Assuntos
Adenocarcinoma de Pulmão/diagnóstico por imagem , Adenocarcinoma de Pulmão/patologia , Antígeno Ki-67/biossíntese , Neoplasias Pulmonares/diagnóstico por imagem , Neoplasias Pulmonares/patologia , Tomografia Computadorizada Multidetectores/métodos , Adulto , Idoso , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Nódulos Pulmonares Múltiplos/patologia , Pleura/patologia , Estudos Retrospectivos
14.
BMC Cancer ; 20(1): 60, 2020 Jan 28.
Artigo em Inglês | MEDLINE | ID: mdl-31992239

RESUMO

BACKGROUND: The value of the CT features and quantitative analysis of lung subsolid nodules (SSNs) in the prediction of the pathological grading of lung adenocarcinoma is discussed. METHODS: Clinical data and CT images of 207 cases (216 lesions) with CT manifestations of an SSNs lung adenocarcinoma confirmed by surgery pathology were retrospectively analysed. The pathological results were divided into three groups, including atypical adenomatous hyperplasia (AAH)/adenocarcinoma in situ (AIS), minimally invasive adenocarcinoma (MIA) and invasive adenocarcinoma (IAC). Then, the quantitative and qualitative data of these nodules were compared and analysed. RESULTS: The mean size, maximum diameter, mean CT value and maximum CT value of the nodules were significantly different among the three groups of AAH/AIS, MIA and IAC and were different between the paired groups (AAH/AIS and MIA or MIA and IAC) (P < 0.05). The critical values of the above indicators between AAH/AIS and MIA were 10.05 mm, 11.16 mm, - 548.00 HU and - 419.74 HU. The critical values of the above indicators between MIA and IAC were 14.42 mm, 16.48 mm, - 364.59 HU and - 16.98 HU. The binary logistic regression analysis of the features with the statistical significance showed that the regression model between AAH/AIS and MIA is logit(p) = - 0.93 + 0.216X1 + 0.004X4. The regression model between MIA and IAC is logit(p) = - 1.242-1.428X5(1) - 1.458X6(1) + 1.146X7(1) + 0.272X2 + 0.005X3. The areas under the curve (AUC) obtained by plotting the receiver operating characteristic curve (ROC) using the regression probabilities of regression models I and II were 0.815 and 0.931. CONCLUSIONS: Preoperative prediction of pathological classification of CT image features has important guiding value for clinical management. Correct diagnosis results can effectively improve the patient survival rate. Through comprehensive analysis of the CT features and qualitative data of SSNs, the diagnostic accuracy of SSNs can be effectively improved. The logistic regression model established in this study can better predict the pathological classification of SSNs lung adenocarcinoma on CT, and the predictive value is significantly higher than the independent use of each quantitative factor.


Assuntos
Adenocarcinoma de Pulmão/diagnóstico por imagem , Adenocarcinoma de Pulmão/patologia , Neoplasias Pulmonares/diagnóstico por imagem , Neoplasias Pulmonares/patologia , Adulto , Idoso , Idoso de 80 Anos ou mais , Área Sob a Curva , Feminino , Humanos , Modelos Logísticos , Masculino , Pessoa de Meia-Idade , Gradação de Tumores , Estudos Retrospectivos
15.
Phys Med Biol ; 65(5): 055012, 2020 03 06.
Artigo em Inglês | MEDLINE | ID: mdl-31978901

RESUMO

To predict the epidermal growth factor receptor (EGFR) mutation status in patients with lung adenocarcinoma using quantitative radiomic biomarkers and semantic features. We analyzed the computed tomography (CT) images and medical record data of 104 patients with lung adenocarcinoma who underwent surgical excision and EGFR mutation detection from 2016 to 2018 at our center. CT radiomic and semantic features that reflect the tumors' heterogeneity and phenotype were extracted from preoperative non-enhanced CT scans. The least absolute shrinkage and selection operator method was applied to select the most distinguishable features. Three logistic regression models were built to predict the EGFR mutation status by combining the CT semantic with clinicopathological characteristics, using the radiomic features alone, and by combining the radiomic and clinicopathological features. Receiver operating characteristic (ROC) curve analysis was performed using five-fold cross-validation and the mean area under the curve (AUC) values were calculated and compared between the models to obtain the optimal model for predicting EGFR mutation. Furthermore, radiomic nomograms were constructed to demonstrate the performance of the model. In total, 1025 radiomic features were extracted and reduced to 13 features as the most important predictors to build the radiomic signature. The combined radiomic and clinicopathological features model was developed based on the radiomic signature, sex, smoking, vascular infiltration, and pathohistological type. The AUC was 0.90 ± 0.02 for the training, 0.88 ± 0.11 for the verification, and 0.894 for the test dataset. This model was superior to the other prediction models that used the combined CT semantic and clinicopathological features (AUC for the test dataset: 0.768) and radiomic features alone (AUC for the test dataset: 0.837). The prediction model built by radiomic biomarkers and clinicopathological features, including the radiomic signature, sex, smoking, vascular infiltration, and pathological type, outperformed the other two models and could effectively predict the EGFR mutation status in patients with peripheral lung adenocarcinoma. The radiomic nomogram of this model is expected to become an effective biomarker for patients with lung adenocarcinoma requiring adjuvant targeted treatment.


Assuntos
Adenocarcinoma de Pulmão/genética , Carcinoma Papilar/genética , Receptores ErbB/genética , Neoplasias Pulmonares/genética , Mutação , Nomogramas , Tomografia Computadorizada por Raios X/métodos , Adenocarcinoma de Pulmão/diagnóstico por imagem , Adenocarcinoma de Pulmão/patologia , Área Sob a Curva , Carcinoma Papilar/diagnóstico por imagem , Carcinoma Papilar/patologia , Feminino , Humanos , Neoplasias Pulmonares/diagnóstico por imagem , Neoplasias Pulmonares/patologia , Masculino , Pessoa de Meia-Idade , Curva ROC , Estudos Retrospectivos
16.
Radiol Med ; 125(3): 257-264, 2020 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-31823295

RESUMO

OBJECTIVE: To investigate the PET/CT findings in lung invasive adenocarcinoma with minor components of micropapillary or solid contents and its association with lymph node metastasis. MATERIALS AND METHODS: A total of 506 lung invasive adenocarcinoma (≤ 3 cm) patients who underwent a PET/CT examination and resection surgery were included. According to the proportion of solid/micropapillary components, the patients were classified into three groups: solid/micropapillary-negative (SMPN) (n = 258), solid/micropapillary-minor (SMPM; > 5% not predominant) (n = 158) and solid/micropapillary-predominant (SMPP; > 5% most dominant) (n = 90). The patients' PET/CT findings, including SUVmax, MTV, TLG and CT characteristics, and other clinical factors were compared by one-way ANOVA test. Logistic regression analysis was done to identify the most predictive findings for lymph node metastasis. RESULTS: The value of SUVmax, MTV, TLG and tumor size was highest in SMPP group, followed by SMPM and SMPN group (P < 0.001).The areas under the curve for SUVmax, MTV and TLG for node metastasis were 0.822, 0.843 and 0.835, respectively. Univariate analysis found that the SMPP and SMPM group had more lymph node metastasis than the SMPN group (P < 0.001). Furthermore, the lymph node metastasis group had higher CEA, SUVmax, MTV, TLG, tumor size and more pleural invasion (P < 0.001). Logistic regression analysis found that SMPP pathological type, SMPM pathological type, higher CEA and male patients were risk factors for lymph node metastasis (P < 0.01). CONCLUSIONS: Lung invasive adenocarcinoma with micropapillary or solid contents had higher SUVmax, MTV, TLG and tumor size and was associated with lymph node metastasis, even if they were not predominant.


Assuntos
Adenocarcinoma de Pulmão/diagnóstico por imagem , Adenocarcinoma Papilar/diagnóstico por imagem , Neoplasias Pulmonares/diagnóstico por imagem , Adenocarcinoma de Pulmão/classificação , Adenocarcinoma de Pulmão/patologia , Adenocarcinoma de Pulmão/secundário , Adenocarcinoma Papilar/classificação , Adenocarcinoma Papilar/patologia , Adenocarcinoma Papilar/secundário , Idoso , Análise de Variância , Área Sob a Curva , Antígeno Carcinoembrionário , Feminino , Humanos , Neoplasias Pulmonares/classificação , Neoplasias Pulmonares/patologia , Metástase Linfática , Masculino , Pessoa de Meia-Idade , Invasividade Neoplásica , Tomografia Computadorizada com Tomografia por Emissão de Pósitrons , Análise de Regressão , Estudos Retrospectivos , Fatores de Risco , Fatores Sexuais , Carga Tumoral
17.
AJR Am J Roentgenol ; 214(2): 437-445, 2020 02.
Artigo em Inglês | MEDLINE | ID: mdl-31714848

RESUMO

OBJECTIVE. The purpose of this study was to explore the value of FDG PET combined with high-resolution CT (HRCT) in predicting the pathologic subtypes and growth patterns of early lung adenocarcinoma. MATERIALS AND METHODS. A retrospective analysis was conducted on the PET/CT data on ground-glass nodules (GGNs) resected from patients with stage IA lung adenocarcinoma. The efficacy of PET maximum standardized uptake value (SUVmax) combined with HRCT signs in prediction of histopathologic subtype and growth pattern of lung adeno-carcinoma was evaluated. RESULTS. SUVmax was significantly higher in GGNs with invasive HRCT signs. The diameter of GGN (odds ratio, 1.660; p = 0.000) and the difference in attenuation value (odds ratio, 1.012; p = 0.011) between ground-glass components and adjacent lung tissues were independent predictors of FDG uptake by GGNs. SUVmax was higher in invasive adenocarcinoma than in adenocarcinoma in situ (AIS)-minimally invasive adenocarcinoma (MIA) (median SUVmax, 2.0 vs 1.1; p = 0.008). An SUVmax of 2.0 was the optimal cutoff value for differentiating invasive adenocarcinoma from AIS-MIA. Acinar-papillary adenocarcinoma had a higher SUVmax than lepidic adenocarcinoma (median SUVmax, 2.1 vs 1.3; p = 0.037). An SUVmax of 1.4 was the optimal cutoff value for differentiating the growth pattern of adenocarcinoma. Use of PET/CT with HRCT significantly improved efficacy for differentiating invasive adeno-carcinoma from AIS-MIA. However, use of HRCT cannot significantly improve the diagnostic efficacy of FDG PET in the evaluation of tumors with different growth patterns. CONCLUSION. FDG PET can be used to predict the histopathologic subtypes and growth patterns of early lung adenocarcinoma. Combined with HRCT, it has value for predicting invasive histopathologic subtypes but no significance for predicting invasive growth patterns.


Assuntos
Adenocarcinoma de Pulmão/diagnóstico por imagem , Tomografia Computadorizada com Tomografia por Emissão de Pósitrons/métodos , Adenocarcinoma de Pulmão/patologia , Adenocarcinoma de Pulmão/cirurgia , Adulto , Idoso , Feminino , Fluordesoxiglucose F18 , Humanos , Masculino , Pessoa de Meia-Idade , Invasividade Neoplásica , Estadiamento de Neoplasias , Compostos Radiofarmacêuticos , Estudos Retrospectivos
19.
Asia Pac J Clin Oncol ; 16(1): 70-74, 2020 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-31782256

RESUMO

AIM: To investigate predictive and prognostic role of metabolic parameters using [18 F]-2-fluoro-2-deoxy-D-glucose positron emission tomography (18 F-FDG PET) in patients with locally advanced non-small cell lung cancer (NSCLC) treated with docetaxel-platinum induction chemotherapy (IC). METHODS: Medical records of 31 patients with pre- and post-IC 18 F-FDG PET were reviewed. Using 18 F-FDG PET, metabolic parameters, including metabolic tumor response, adjusted peak standardized uptake values using lean body mass at baseline (pre-SULpeak ) and after IC (post-SULpeak ), and percentage change of pre- and post-SULpeak (ΔSULpeak ), were assessed. RESULTS: Response rate (RR) was 71%, with a metabolic RR of 83.9%. Nineteen (61.3%) patients underwent surgery, R0 resection was achieved for 17 (89.5%) patients. Median relapse-free survival (RFS) and overall survival (OS) were 8.9 months (95% CI: 4.5-12.1) and 24.1 months (95% CI: 17.1-34.1), respectively. Post-SULpeak  < 2 was identified as a favorable prognostic factor for RFS (hazard ratio [HR]: 0.12; P = .004), while ΔSULpeak ≥60% and R0 resection were found as positive prognostic factors for OS (HR: 0.09 and 0.13; P = .011 and P = .042, respectively). Using a receiver operating characteristics curve, post-SULpeak  > 1.4 could predict recurrence with a sensitivity of 84% and a specificity of 100%. CONCLUSION: In patients with locally advanced NSCLC receiving IC, post-SULpeak and ΔSULpeak showed clinical significance for survival outcome.


Assuntos
Carcinoma Pulmonar de Células não Pequenas/patologia , Fluordesoxiglucose F18/metabolismo , Quimioterapia de Indução/métodos , Neoplasias Pulmonares/patologia , Tomografia por Emissão de Pósitrons/métodos , Compostos Radiofarmacêuticos/metabolismo , Adenocarcinoma de Pulmão/diagnóstico por imagem , Adenocarcinoma de Pulmão/tratamento farmacológico , Adenocarcinoma de Pulmão/metabolismo , Adenocarcinoma de Pulmão/patologia , Adulto , Idoso , Carcinoma Pulmonar de Células não Pequenas/diagnóstico por imagem , Carcinoma Pulmonar de Células não Pequenas/tratamento farmacológico , Carcinoma Pulmonar de Células não Pequenas/metabolismo , Carcinoma de Células Escamosas/diagnóstico por imagem , Carcinoma de Células Escamosas/tratamento farmacológico , Carcinoma de Células Escamosas/metabolismo , Carcinoma de Células Escamosas/patologia , Feminino , Humanos , Neoplasias Pulmonares/diagnóstico por imagem , Neoplasias Pulmonares/tratamento farmacológico , Neoplasias Pulmonares/metabolismo , Masculino , Pessoa de Meia-Idade , Recidiva Local de Neoplasia/diagnóstico por imagem , Recidiva Local de Neoplasia/tratamento farmacológico , Recidiva Local de Neoplasia/metabolismo , Recidiva Local de Neoplasia/patologia , Prognóstico , Taxa de Sobrevida
20.
Clin Nucl Med ; 45(1): e63-e64, 2020 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-31652158

RESUMO

A 72-year-old man with a history of T1cN0M0 prostate adenocarcinoma and rising prostate-specific antigen underwent a fluciclovine PET/CT scan that showed high uptake in several para-aortic nodes, suspicious for prostate cancer. A right upper lobe single pulmonary nodule (SPN), demonstrated only mild uptake, which raised the suspicion for a lung primary. Subsequent FDG PET/CT showed high uptake in the SPN, revealing poorly differentiated adenocarcinoma at biopsy, but with no abnormal uptake in the para-aortic nodes. This case highlights the complementary potential of fluciclovine and FDG PET in patients with a history of prostate cancer biochemical recurrence and SPN.


Assuntos
Adenocarcinoma de Pulmão/diagnóstico por imagem , Adenocarcinoma de Pulmão/metabolismo , Ácidos Carboxílicos/metabolismo , Ciclobutanos/metabolismo , Fluordesoxiglucose F18/metabolismo , Tomografia Computadorizada com Tomografia por Emissão de Pósitrons , Neoplasias da Próstata/diagnóstico por imagem , Neoplasias da Próstata/metabolismo , Adenocarcinoma de Pulmão/patologia , Idoso , Transporte Biológico , Humanos , Masculino , Neoplasias Primárias Múltiplas/diagnóstico por imagem , Neoplasias Primárias Múltiplas/metabolismo , Neoplasias Primárias Múltiplas/patologia , Neoplasias da Próstata/patologia , Recidiva
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