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1.
Medicine (Baltimore) ; 100(3): e23979, 2021 Jan 22.
Artigo em Inglês | MEDLINE | ID: mdl-33545984

RESUMO

ABSTRACT: Electromagnetic navigational bronchoscopy (ENB) combined with a radial endobronchial ultrasound probe realizes a combination of magnetic navigation and ultrasound imaging, allowing for the accurate navigation of peripheral lung lesions in real time during surgery. ENB has been evaluated in many studies. However, a comparative report on the feasibility of ENB combined radial endobronchial ultrasound diagnosis in different density lung nodules was small, and few of these studies have reported long-term follow-up results to exclude false negative results. The aim of this study is to explore the applicability of ENB combined radial endobronchial ultrasound in the diagnosis of lung nodules with different densities.Patients underwent biopsy in our medical center from 2016-09 to 2019-03 were divided into 2 groups: the solid nodule group and the subsolid pulmonary nodule group. We collected and analyzed the diagnostic accuracy, the diagnostic yield, the false negative rate and the incidence of complications between these 2 groups.A total of 37 lesions in 25 patients were biopsied, 14 lesions were subsolid pulmonary nodules and 23 were solid nodules. The diagnostic accuracy (success rate to obtain meaningful pathology tissues) was 34/37 (91.8%). Lost to follow-up in 1 case and three cases were undiagnosed. After at least 12 months of follow-up, the total diagnostic yield (true positive rate+ true negative rate) was 27/36 (75%) (P = .006). The false negative rate was 9/19 (47.3%) (P = .26). Complications occurred in 1/36 (2.7%) lesions. For the subsolid pulmonary nodule group, the diagnostic accuracy was 13/14 (92.8%) and the diagnostic yield was 7/14 (50%). For the solid nodule group, the diagnostic accuracy was 21/23 (91.3%), and the diagnostic yield was 20/22 (90.9%).Electromagnetic navigational bronchoscopy combined with radial endobronchial ultrasound in peripheral lung nodule biopsies is safe and effective, especially for solid nodules, but the diagnostic yield in subsolid nodule biopsies remains to be improved.


Assuntos
Broncoscopia/métodos , Pulmão/diagnóstico por imagem , Nódulo Pulmonar Solitário/diagnóstico por imagem , Ultrassonografia/métodos , Idoso , China , Radiação Eletromagnética , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos , Nódulo Pulmonar Solitário/diagnóstico , Nódulo Pulmonar Solitário/fisiopatologia
2.
BMJ Case Rep ; 14(2)2021 Feb 01.
Artigo em Inglês | MEDLINE | ID: mdl-33526536

RESUMO

A 49-year-old man with a 37.5 pack-year smoking history presented with a suspected neoplasm of the right lung following the discovery of a metabolically active mass on positron emission tomography-CT imaging. The patient, who demonstrated poor oral hygiene, had a history of irregular problem-oriented dental visitation. Having excluded malignancy through histologic investigations, Aggregatibacter actinomycetemcomitans-a well-established periodontal pathogen-was subsequently cultured from his pulmonary aspirate. The patient was therefore managed with systemic antimicrobials and adjunctive dental extractions to eliminate the likely source of infection, whereafter the mass resolved without complication. This case corroborates previous reports of extraoral isolation of A. actinomycetemcomitans, which may mimic cancer clinically and radiographically. While a definitive causative link between untreated periodontitis and systemic infection remains to be elucidated, such cases present a compelling argument in favour of promoting oral health to prevent systemic disease.


Assuntos
Aggregatibacter actinomycetemcomitans/isolamento & purificação , Diagnóstico Diferencial , Abscesso Pulmonar/diagnóstico por imagem , Neoplasias Pulmonares/diagnóstico , Infecções por Pasteurellaceae/diagnóstico , Periodontite/diagnóstico , Nódulo Pulmonar Solitário/diagnóstico por imagem , Biópsia por Agulha Fina , Secções Congeladas , Humanos , Abscesso Pulmonar/tratamento farmacológico , Masculino , Pessoa de Meia-Idade , Infecções por Pasteurellaceae/tratamento farmacológico , Periodontite/complicações , Periodontite/terapia , Tomografia Computadorizada com Tomografia por Emissão de Pósitrons , Radiografia Panorâmica , Radiografia Torácica , Cirurgia Torácica Vídeoassistida , Tomografia Computadorizada por Raios X
3.
Zhongguo Yi Liao Qi Xie Za Zhi ; 45(1): 32-36, 2021 Feb 08.
Artigo em Chinês | MEDLINE | ID: mdl-33522173

RESUMO

The magnetic anchoring lung nodule positioning device is composed of a target magnet, an anchor magnet, a coaxial puncture needle and a puncture navigation template, through these, a new type of accurate positioning technology for small pulmonary nodules is derived. The device inserts the target magnet into the both sides nearby the lung nodule under the guidance of CT. Helped by the mutual attraction of the two target magnets, they can be fixed in the lung tissue, avoiding the movement in the lung, and accurately positioning the target lung nodule before surgery. In thoracoscopic surgery, the anchor magnet and the target magnet attract each other to achieve the purpose of positioning the target nodule. The device uses the characteristics of non-contact suction of magnetic materials biomedical engineering technology, eliminating the previous procedure of direct interaction with the positioning marks, finally achieves the target of precise positioning of lung nodules and rapid surgical removal.


Assuntos
Nódulo Pulmonar Solitário , Humanos , Pulmão , Neoplasias Pulmonares , Fenômenos Magnéticos , Imãs , Cirurgia Torácica Vídeoassistida , Tomografia Computadorizada por Raios X
4.
Zhonghua Zhong Liu Za Zhi ; 43(1): 137-142, 2021 Jan 23.
Artigo em Chinês | MEDLINE | ID: mdl-33472327

RESUMO

Objective: To explore the feasibility, safety and effectiveness of anatomical partial lobectomy. Methods: The clinical data of 3 336 patients with lung nodules underwent anatomical partial lobectomy in our center from November 2013 to November 2019 were retrospectively analyzed. We set the safety margin distance according to the imaging feature of the lesion. The surgeons then anatomically detached the major vessels and bronchus in this region, resected the targeted lung tissue along the plane, and completed the resection of anatomical pulmonary lobe and clean and sampling of systemic lymph nodules. Results: A total of 668 cases were multiple nodules and 2 668 cases were solitary pulmonary nodules. According to the postoperative pathological results, 283 cases were benign, 1 197 cases were preinvasive lesions (including 38 cases of atypical adenomatous hyperplasia, 445 cases of adenocarcinoma in situ and 714 cases of minimally invasive adenocarcinoma), 1 713 cases were invasive adenocarcinoma, 73 cases were non-adenocarcinoma and 70 cases were metastatic carcinoma. Among 1 786 invasive primary lung cancers, 11 cases received preoperative neoadjuvant chemotherapy, and their postoperative pathologic diagnoses were stage ypIA. Other 1 775 cases who did not receive postoperative neoadjuvant treatment included 1 587 cases in stage ⅠA, 112 cases in stage ⅠB, 3 cases in stage ⅡA, 18 cases in stage ⅡB, 37 cases in stage ⅢA, 9 cases in stage ⅢB, 9 cases in stage Ⅳ. The average operation time was (127.3±55.3) minutes, and the mean postoperative hospital stay was (4.8±2.4) days. The incidence rate of complications (grade>2) was 1.1%(38/3 336), and no death occurred during 30 days after operation. Conclusion: Anatomic partial lobectomy has good clinical applicability, safety and effectiveness, which is worthy of clinical application and recommendation.


Assuntos
Neoplasias Pulmonares , Nódulo Pulmonar Solitário , Humanos , Pulmão , Neoplasias Pulmonares/cirurgia , Estudos Retrospectivos , Nódulo Pulmonar Solitário/diagnóstico por imagem , Nódulo Pulmonar Solitário/cirurgia , Cirurgia Torácica Vídeoassistida
5.
Magn Reson Imaging ; 75: 100-106, 2021 01.
Artigo em Inglês | MEDLINE | ID: mdl-33096226

RESUMO

OBJECTIVE: To test the performance of free-breathing Dynamic Contrast-Enhanced MRI (DCE-MRI) using a radial volumetric interpolated breath-hold examination (VIBE) sequence combined with diffusion-weighted imaging (DWI) for quantitative solitary pulmonary nodule (SPN) assessment. METHODS: A total of 67 SPN cases receiving routine MRI routine scans, DWI, and dynamic-enhanced MRI in our hospital from May 2017 to November 2018 were collected. These cases were divided into a malignant group and a benign group according to the characteristics of the SPNs. The quantitative DCE-MRI parameters (Ktrans, Kep, Ve) and apparent diffusion coefficient (ADC) values of the nodules were measured. RESULTS: The Ktrans and Kep values in the malignant group were higher than those in the benign group, while the ADC values in the malignant group were lower than those in the benign group. Furthermore, the Ktrans value of adenocarcinoma was higher than that of squamous cell carcinoma and small cell carcinoma (P < 0.05). The Ve value was significantly different between non-small cell carcinoma and small cell carcinoma (P < 0.05). With an ADC value of 0.98 × 10-3 mm2/s as the threshold, the specificity and sensitivity to diagnose benign and malignant nodules was 90.6% and 80%, respectively. CONCLUSION: High-temporal-resolution DCE-MRI using the r-VIBE technique in combination with DWI could contribute to pulmonary nodule analysis and possibly serve as a potential alternative to distinguish malignant from benign nodules as well as differentiate different types of malignancies.


Assuntos
Suspensão da Respiração , Imagem de Difusão por Ressonância Magnética , Processamento de Imagem Assistida por Computador , Nódulo Pulmonar Solitário/diagnóstico por imagem , Adenocarcinoma/diagnóstico por imagem , Adenocarcinoma/fisiopatologia , Adulto , Idoso , Carcinoma de Células Escamosas/diagnóstico por imagem , Carcinoma de Células Escamosas/fisiopatologia , Meios de Contraste , Diagnóstico Diferencial , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Sensibilidade e Especificidade , Nódulo Pulmonar Solitário/fisiopatologia
6.
Br J Radiol ; 94(1117): 20200633, 2021 Jan 01.
Artigo em Inglês | MEDLINE | ID: mdl-33125260

RESUMO

OBJECTIVE: To develop and validate a CT-based nomogram to predict the occurrence of loculated pneumothorax due to hook wire placement. METHODS: Patients (n = 177) were divided into pneumothorax (n = 72) and non-pneumothorax (n = 105) groups. Multivariable logistic regression analysis was applied to build a clinical prediction model using significant predictors identified by univariate analysis of imaging features and clinical factors. Receiver operating characteristic (ROC) was applied to evaluate the discrimination of the nomogram, which was calibrated using calibration curve. RESULTS: Based on the results of multivariable regression analysis, transfissure approach [odds ratio (OR): 757.94; 95% confidence interval CI (21.20-27099.30) p < 0.0001], transemphysema [OR: 116.73; 95% CI (12.34-1104.04) p < 0.0001], localization of multiple nodules [OR: 8.04; 95% CI (2.09-30.89) p = 0.002], and depth of nodule [OR: 0.77; 95% CI (0.71-0.85) p < 0.0001] were independent risk factors for pneumothorax and were included in the predictive model (p < 0.05). The area under the ROC curve value for the nomogram was 0.95 [95% CI (0.92-0.98)] and the calibration curve indicated good consistency between risk predicted using the model and actual risk. CONCLUSION: A CT-based nomogram combining imaging features and clinical factors can predict the probability of pneumothorax before localization of ground-glass nodules. The nomogram is a decision-making tool to prevent pneumothorax and determine whether to proceed with further treatment. ADVANCES IN KNOWLEDGE: A nomogram composed of transfissure, transemphysema, multiple nodule localization, and depth of nodule has been developed to predict the probability of pneumothorax before localization of GGNs.


Assuntos
Neoplasias Pulmonares/diagnóstico por imagem , Pneumotórax/diagnóstico por imagem , Cuidados Pré-Operatórios/métodos , Nódulo Pulmonar Solitário/diagnóstico por imagem , Cirurgia Torácica Vídeoassistida/instrumentação , Tomografia Computadorizada por Raios X/métodos , Feminino , Humanos , Pulmão/diagnóstico por imagem , Masculino , Pessoa de Meia-Idade , Nomogramas , Pneumotórax/etiologia , Valor Preditivo dos Testes , Cuidados Pré-Operatórios/instrumentação , Radiografia Intervencionista , Reprodutibilidade dos Testes , Cirurgia Torácica Vídeoassistida/efeitos adversos , Cirurgia Torácica Vídeoassistida/métodos
7.
Br J Radiol ; 94(1118): 20200089, 2021 Feb 01.
Artigo em Inglês | MEDLINE | ID: mdl-33353396

RESUMO

OBJECTIVE: To investigate the effect of reducing pixel size on the consistency of radiomic features and the diagnostic performance of the downstream radiomic signatures for the invasiveness for pulmonary ground-glass nodules (GGNs) on CTs. METHODS: We retrospectively collected the clinical data of 182 patients with GGNs on high resolution CT (HRCT). The CT images of different pixel sizes (0.8mm, 0.4mm, 0.18 mm) were obtained by reconstructing the single HRCT scan using three combinations of field of view and matrix size. For each pixel size setting, radiomic features were extracted for all GGNs and radiomic signatures for the invasiveness of GGNs were built through two modeling pipelines for comparison. RESULTS: The study finally extracted 788 radiomic features. 87% radiomic features demonstrated inter pixel size variation. By either modeling pipeline, the radiomic signature under small pixel size performed significantly better than those under middle or large pixel sizes in predicting the invasiveness of GGNs (p's value <0.05 by Delong test). With the independent modeling pipeline, the three pixel size bounded radiomic signatures shared almost no common features. CONCLUSIONS: Reducing pixel size could cause inconsistency in most radiomic features and improve the diagnostic performance of the downstream radiomic signatures. Particularly, super HRCTs with small pixel size resulted in more accurate radiomic signatures for the invasiveness of GGNs. ADVANCES IN KNOWLEDGE: The dependence of radiomic features on pixel size will affect the performance of the downstream radiomic signatures. The future radiomic studies should consider this effect of pixel size.


Assuntos
Adenocarcinoma de Pulmão/diagnóstico por imagem , Adenocarcinoma de Pulmão/patologia , Neoplasias Pulmonares/diagnóstico por imagem , Neoplasias Pulmonares/patologia , Nódulo Pulmonar Solitário/diagnóstico por imagem , Nódulo Pulmonar Solitário/patologia , Tomografia Computadorizada por Raios X/métodos , Adulto , Feminino , Humanos , Pulmão/diagnóstico por imagem , Pulmão/patologia , Masculino , Pessoa de Meia-Idade , Invasividade Neoplásica/diagnóstico por imagem , Invasividade Neoplásica/patologia , Reprodutibilidade dos Testes , Estudos Retrospectivos , Sensibilidade e Especificidade
8.
Clin Imaging ; 69: 332-338, 2021 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-33059184

RESUMO

INTRODUCTION: This study assessed (i) the ability to identify the solid components of part-solid nodules (PSN) during computed tomography (CT) guided lung biopsy (CTGLB), (ii) the ability of CTGLB to assess the invasive nature of a nodule on pathology. MATERIALS AND METHODS: Sixty-nine nodules were studied in 68 patients who underwent CTGLB between 1/1/2014 and 10/31/2015. Diagnostic CT images and CTGLB images were reviewed. On diagnostic CT images, nodules were classified as ground glass nodules (GGN) or PSNs. Nodule size, location, and percentage of solid component were recorded. At the time of biopsy, the ability to visualize the solid component of a PSN, depth of lesion from skin, and ability to identify the needle within the solid component were recorded. RESULTS: There were 42 (61%) part-solid nodules and 27 (39%) GGNs. During biopsy, it was possible to differentiate the solid from the ground glass components in 35 (83%) PSNs. Fifty-nine (86%) nodules were neoplastic based on biopsy pathology (all non-small cell lung carcinoma). Thirty-nine (66%) were resected. In all cases biopsy pathology and surgical pathology agreed regarding the presence of lung carcinoma. In 6 (15%) cases biopsy pathology demonstrated purely lepidic growth but had some non-lepidic growth on surgical pathology, including 2 cases with acinar growth as a dominant pattern. CONCLUSION: In most patients, the solid and ground glass components of a PSN were distinguishable when performing a CTGLB. In a minority of patients, discrepancy was noted between biopsy pathology and surgical pathology regarding the invasive nature of a nodule.


Assuntos
Adenocarcinoma , Neoplasias Pulmonares , Nódulo Pulmonar Solitário , Humanos , Neoplasias Pulmonares/diagnóstico por imagem , Estudos Retrospectivos , Nódulo Pulmonar Solitário/diagnóstico por imagem , Tempo , Tomografia Computadorizada por Raios X
10.
Medicine (Baltimore) ; 99(43): e22440, 2020 Oct 23.
Artigo em Inglês | MEDLINE | ID: mdl-33120738

RESUMO

To assess the prevalence and missed reporting rate of potential clinically-significant incidental findings (IFs) in the neck CTA scans.All consecutive patients undergoing neck CTA imaging, from January 1, 2017 to December 31, 2018, were retrospectively evaluated by a radiologist for the presence of incidental findings in the upper chest, lower head and neck regions. These incidental findings were subsequently classified into 3 categories in terms of clinical significance: Type I, highly significant, Type II, moderately significant; and Type III, mildly or not significant. Type I and Type II IFs were determined as potential clinically significant ones and were retrospectively analyzed by another 2 radiologists in consensus. The undiagnosed findings were designated as those that were not reported by the initial radiologists. The differences in the rate of unreported potential clinically significant IFs were compared between the chest group and head or neck group.A total of 376 potential clinically significant IFs were detected in 1,698 (91.19%) patients, of which 175 IFs were classified as highly significant findings (Type I), and 201 (53.46%) as moderately significant findings (Type II). The most common potential clinically significant findings included thyroid nodules (n = 88, 23.40%), pulmonary nodules (n = 56, 14.89%), sinus disease (n = 39, 10.37%), intracranial or cervical artery aneurysms (n = 30, 7.98%), enlarged lymph nodes (n = 24, 6.38%), and pulmonary embolism (n = 19, 5.05%). In addition, 184 (48.94%) of them were not mentioned in the initial report. The highest incidence of missed potential clinical findings were pulmonary embolism and pathologic fractures and erosions (100% for both). The unreported rate of the chest group was significantly higher than that of the head or neck one, regardless of Type I, Type II or all potential clinically significant IFs (χ = 32.151, χ = 31.211, χ = 65.286, respectively; P < .001 for all).Important clinically significant incidental findings are commonly found in a proportion of patients undergoing neck CTA, in which nearly half of these patients have had potential clinically significant IFs not diagnosed in the initial report. Therefore, radiologists should beware of the importance of and the necessity to identify incidental findings in neck CTA scans.


Assuntos
Angiografia por Tomografia Computadorizada , Achados Incidentais , Diagnóstico Ausente/estatística & dados numéricos , Adulto , Idoso , Idoso de 80 Anos ou mais , Feminino , Humanos , Processamento de Imagem Assistida por Computador , Aneurisma Intracraniano/diagnóstico por imagem , Doenças Linfáticas/diagnóstico por imagem , Masculino , Pessoa de Meia-Idade , Tomografia Computadorizada Multidetectores , Nódulos Pulmonares Múltiplos/diagnóstico por imagem , Doenças dos Seios Paranasais/diagnóstico por imagem , Embolia Pulmonar/diagnóstico por imagem , Estudos Retrospectivos , Nódulo Pulmonar Solitário/diagnóstico por imagem , Nódulo da Glândula Tireoide/diagnóstico por imagem
11.
Rev Med Liege ; 75(10): 633-635, 2020 Oct.
Artigo em Francês | MEDLINE | ID: mdl-33030836

RESUMO

During the follow-up of oncologic patients, pulmonary nodules are frequently discovered and pose a challenge to radiologists. Eventhough metastatic origin is often proposed, a thorough imaging protocol including non- and contrast-enhanced computed tomography combined with advanced reconstruction techniques, can be of a great support in proposing alternative diagnosis and adequate complementary treatment. This statement is illustrated by the case of a 60-year-old patient in which a pulmonary nodule diagnosed first as a metastasis, proved to be an aneurysmal pulmonary formation.


Assuntos
Neoplasias Pulmonares , Nódulos Pulmonares Múltiplos , Nódulo Pulmonar Solitário , Humanos , Pulmão , Pessoa de Meia-Idade , Nódulos Pulmonares Múltiplos/diagnóstico por imagem , Nódulo Pulmonar Solitário/diagnóstico por imagem , Tomografia Computadorizada por Raios X
12.
J Vasc Interv Radiol ; 31(10): 1682.e1-1682.e7, 2020 10.
Artigo em Inglês | MEDLINE | ID: mdl-32868129

RESUMO

PURPOSE: To assess outcomes of computed tomography (CT)-guided methylene blue/collagen marking of preoperative lung nodules before video-assisted thoracoscopic surgery (VATS) and robotic-assisted thoracic surgery (RATS). MATERIALS AND METHODS: A retrospective cohort study assessing 25 methylene blue/collagen solution CT-guided lung nodule localization procedures on 26 nodules in 25 patients was performed. The procedures were performed by a fellowship-trained radiologist 1-2 hours before scheduled surgery under local anesthesia. Approximately 4-6 ml of methylene blue/collagen solution was injected in a perinodular location under CT guidance with a 19-gauge trocar needle and along the track to the visceral pleural surface. Post-procedural CT images confirmed appropriate lung nodule location marking. RESULTS: Perinodular CT-guided trocar needle placement was achieved in all marking procedures (n = 26/26). Increased consolidation near the target nodule was also demonstrated in all patients on the post-procedural localized CT scans. One patient with moderate emphysema developed a small to moderate-sized pneumothorax (∼20%-30%), and an 8-Fr thoracentesis catheter was placed under CT guidance before surgery. There was no bleeding or hemoptysis in any patient. Methylene blue/collagen solution was readily visible by the thoracic surgeon in association with all target nodules. One patient required conversion to open procedure due to the proximal portion of the right lower lobe pulmonary artery segmental branch. Of the 26 identified nodules, pathology specimens confirmed the adequacy of nodule resection in all cases. CONCLUSIONS: Preoperative CT-guided methylene blue/collagen solution injection offers a safe and highly effective technique for marking subpleural lung nodules undergoing VATS or RATS.


Assuntos
Colágeno/administração & dosagem , Corantes/administração & dosagem , Neoplasias Pulmonares/patologia , Azul de Metileno/administração & dosagem , Nódulos Pulmonares Múltiplos/patologia , Cuidados Pré-Operatórios , Radiografia Intervencionista , Nódulo Pulmonar Solitário/patologia , Tomografia Computadorizada por Raios X , Humanos , Injeções , Neoplasias Pulmonares/diagnóstico por imagem , Neoplasias Pulmonares/cirurgia , Nódulos Pulmonares Múltiplos/diagnóstico por imagem , Nódulos Pulmonares Múltiplos/cirurgia , Pneumonectomia , Valor Preditivo dos Testes , Estudos Retrospectivos , Procedimentos Cirúrgicos Robóticos , Nódulo Pulmonar Solitário/diagnóstico por imagem , Nódulo Pulmonar Solitário/cirurgia , Cirurgia Torácica Vídeoassistida , Carga Tumoral
13.
J Cancer Res Ther ; 16(4): 780-787, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32930118

RESUMO

Background: There are "blind spots" on chest computed tomography (CT) where pulmonary nodules can easily be overlooked. The number of missed pulmonary nodules can be minimized by instituting a training program with particular focus on the depiction of nodules at blind spots. Purpose: The purpose of this study was to assess the variation in lung nodule detection in chest CT based on location, attenuation characteristics, and reader experience. Materials and Methods: We selected 18 noncalcified lung nodules (6-8 mm) suspicious of primary and metastatic lung cancer with solid (n = 7), pure ground-glass (6), and part-solid ground-glass (5) attenuation from 12 chest CT scans. These nodules were randomly inserted in chest CT of 34 patients in lung hila, 1st costochondral junction, branching vessels, paramediastinal lungs, lung apices, juxta-diaphragm, and middle and outer thirds of the lungs. Two residents and two chest imaging clinical fellows evaluated the CT images twice, over a 4-month interval. Before the second reading session, the readers were trained and made aware of the potential blind spots. Chi-square test was used to assess statistical significance. Results: Pretraining session: Fellows detected significantly more part-solid ground-glass nodules compared to residents (P = 0.008). A substantial number of nodules adjacent to branching vessels and posterior mediastinum were missed. Posttraining session: There was a significant increase in detectability independent of attenuation and location of nodules for all readers (P < 0.0008). Conclusion: Dedicated chest CT training improves detection of lung nodules, especially the part-solid ground-glass nodules. Detection of nodules adjacent to branching vessels and the posterior mediastinal lungs is difficult even for fellowship-trained radiologists.


Assuntos
Neoplasias Pulmonares/diagnóstico , Nódulos Pulmonares Múltiplos/diagnóstico , Radiologia/educação , Treinamento por Simulação/métodos , Nódulo Pulmonar Solitário/diagnóstico , Adulto , Idoso , Idoso de 80 Anos ou mais , Algoritmos , Detecção Precoce de Câncer/métodos , Feminino , Humanos , Neoplasias Pulmonares/diagnóstico por imagem , Neoplasias Pulmonares/patologia , Masculino , Mediastino/diagnóstico por imagem , Mediastino/patologia , Pessoa de Meia-Idade , Nódulos Pulmonares Múltiplos/diagnóstico por imagem , Nódulos Pulmonares Múltiplos/patologia , Lesões Pré-Cancerosas/diagnóstico por imagem , Lesões Pré-Cancerosas/patologia , Interpretação de Imagem Radiográfica Assistida por Computador/métodos , Radiologia/métodos , Software , Nódulo Pulmonar Solitário/diagnóstico por imagem , Tomografia Computadorizada por Raios X/métodos
14.
Nan Fang Yi Ke Da Xue Xue Bao ; 40(5): 718-722, 2020 May 30.
Artigo em Chinês | MEDLINE | ID: mdl-32897207

RESUMO

ObjectiveTo evaluate the value and clinical effect of different preoperative localization techniques for solitary pulmonary nodules (SPN) before single-port thoracoscopic surgery.MethodFrom January 2018 to June 2019, 54 patients diagnosed with solitary pulmonary nodules received single-port thoracoscopic surgery in Thoracic Department of General Hospital of Southern Theater Command of PLA. Based on the location methods of the nodules, the patients were divided into group A (34 cases) with preoperative CT-guided Hook-wire (a common positioning needle usually using in mammary gland) positioning and group B (20 cases) with preoperative CT-guided methylene blue location.ResultsThe success rate of localization in group A was 94.18% (32/34), significantly higher than that in group B [85% (17/20), P < 0.05). No intraoperative conversion to thoracotomy occurred in group A, while the conversion rate was 10% (2/20) in group B (P < 0.05). The average positioning cost was significantly higher in group A than in group B (1715±109 vs 1021±86 RMB yuan, P < 0.05), but the total hospitalization cost was similar between the two groups (50 114±3788 vs 47871±5902 RMB yuan, P>0.05). The length of hospital stay was significantly shorter in group A than in group B (6.71±1.23 vs 8.19±2.61 days, P < 0.05).ConclusionCompared with the traditional methylene blue localization method, Hook-wire localization positioning can significantly increase the success rate of localization, and can be used as the standard preoperative localization method in patients undergoing single-port thoracoscopic pulmonary nodule resection, especially in those with deep nodule location from the visceral pleura.


Assuntos
Neoplasias Pulmonares , Nódulo Pulmonar Solitário , Humanos , Cuidados Pré-Operatórios , Cirurgia Torácica Vídeoassistida , Tomografia Computadorizada por Raios X
15.
PLoS One ; 15(8): e0235672, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32845877

RESUMO

A new computer-aided detection scheme is proposed, the 3D U-Net convolutional neural network, based on multiscale features of transfer learning to automatically detect pulmonary nodules from the thoracic region containing background and noise. The test results can be used as reference information for doctors to assist in the detection of early lung cancer. The proposed scheme is composed of three major steps: First, the pulmonary parenchyma area is segmented by various methods. Then, the 3D U-Net convolutional neural network model with a multiscale feature structure is built. The network model structure is subsequently fine-tuned by the transfer learning method based on weight, and the optimal parameters are selected in the network model. Finally, datasets are extracted to train the fine-tuned 3D U-Net network model to detect pulmonary nodules. The five-fold cross-validation method is used to obtain the experimental results for the LUNA16 and TIANCHI17 datasets. The experimental results show that the scheme not only has obvious advantages in the detection of medium and large-sized nodules but also has an accuracy rate of more than 70% for the detection of small-sized nodules. The scheme provides automatic and accurate detection of pulmonary nodules that reduces the overfitting rate and training time and improves the efficiency of the algorithm. It can assist doctors in the diagnosis of lung cancer and can be extended to other medical image detection and recognition fields.


Assuntos
Imageamento Tridimensional/métodos , Neoplasias Pulmonares/diagnóstico por imagem , Pulmão/diagnóstico por imagem , Redes Neurais de Computação , Nódulo Pulmonar Solitário/diagnóstico por imagem , Algoritmos , Detecção Precoce de Câncer/métodos , Humanos , Aprendizado de Máquina , Interpretação de Imagem Radiográfica Assistida por Computador/métodos , Tomografia Computadorizada por Raios X/métodos
16.
Hum Cell ; 33(4): 1252-1263, 2020 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-32776306

RESUMO

The significance of the polypeptide N-acetyl-galactosaminyl transferase-3 (GalNAc-T3) and mucin 1 (MUC1) in solitary pulmonary adenocarcinoma (SPA) initially diagnosed as malignant solitary pulmonary nodule (≤ 3 cm), especially as a combined predictor of prognosis and recurrence, was explored in this study. A retrospective analysis of 83 patients with SPA (≤ 3 cm), which revealed postoperative pathological diagnosis was lung adenocarcinoma after complete resection. Immunohistochemical staining was used to detect the expression of GalNAc-T3 and MUC1 in primary tumor specimens. The relationship between expression and various clinicopathological factors was analyzed, as well as the effects of patients' overall survival (OS) and disease-free survival (DFS). In all patients, GalNAc-T3 was highly expressed in 53 (63.9%) cases; MUC1 was highly expressed in 31 (37.3%) cases. The GalNAc-T3 expression was correlated with differentiation, pathological risk group, N stage, and TNM stage. The group with high GalNAc-T3 expression and low MUC1 expression (GalNAc-T3Hig/MUC1Low) is correlated to pathological differentiation and has a trend related to the TNM stage. The patients with better differentiation, lower pathological risk group, lower N stage, and GalNAc-T3 high expression had better overall survival, especially the GalNAc-T3Hig/MUC1Low group. Moreover, the moderate differentiation, N3 stage, and GalNAc-T3Hig/MUC1Low group were independent predictive factors for OS. Besides, patients with lower N stage, lower TNM stage, higher GalNAc-T3 expression got better disease-free survival (DFS), especially the GalNAc-T3Hig/MUC1Low group. The GalNAc-T3Hig/MUC1Low group was an independent predictive factor for DFS. In conclusion, GalNAc-T3 and MUC1 were combined predictors of prognosis and recurrence in SPA (≤ 3 cm).


Assuntos
Adenocarcinoma de Pulmão/diagnóstico , Biomarcadores Tumorais/análise , Biomarcadores Tumorais/genética , Expressão Gênica , Neoplasias Pulmonares/diagnóstico , Mucina-1/análise , Mucina-1/genética , N-Acetilgalactosaminiltransferases/análise , N-Acetilgalactosaminiltransferases/genética , Recidiva Local de Neoplasia/diagnóstico , Nódulo Pulmonar Solitário/diagnóstico , Adenocarcinoma de Pulmão/genética , Adenocarcinoma de Pulmão/patologia , Idoso , Idoso de 80 Anos ou mais , Diagnóstico Diferencial , Feminino , Seguimentos , Humanos , Neoplasias Pulmonares/genética , Neoplasias Pulmonares/patologia , Masculino , Pessoa de Meia-Idade , Recidiva Local de Neoplasia/genética , Recidiva Local de Neoplasia/patologia , Estadiamento de Neoplasias , Valor Preditivo dos Testes , Prognóstico , Estudos Retrospectivos
19.
Ther Umsch ; 77(2): 75-80, 2020.
Artigo em Alemão | MEDLINE | ID: mdl-32633224

RESUMO

Pulmonary nodules - an overview Abstract. Computed tomography (CT) offers fast temporal and high spatial resolution and is increasingly employed for various investigations. Since the 1990s, when multislice computed tomography (CT) technique became commonly available, the detection rate of incidentally detected pulmonary nodules has increased. The aetiology of pulmonary nodules can range from infectious over interstitial lung disease to malignant entities and pose a diagnostic dilemma: Should the incidental finding be dismissed or further investigated? If further investigated which modality and which time frame should be used? Due to the multidisciplinary nature of data required for the complex assessment of an incidental pulmonary nodule, management guidelines are needed in the diagnostic process such as those proposed by the Fleischner Society. The aim of this review is to discuss the different aetiologies pf pulmonary nodules and their potential work-up. Finally, we will also discuss the utility of lung cancer screening.


Assuntos
Neoplasias Pulmonares , Nódulos Pulmonares Múltiplos/diagnóstico por imagem , Nódulos Pulmonares Múltiplos/diagnóstico , Nódulo Pulmonar Solitário/diagnóstico por imagem , Nódulo Pulmonar Solitário/diagnóstico , Detecção Precoce de Câncer , Humanos , Achados Incidentais , Tomografia Computadorizada por Raios X
20.
Medicine (Baltimore) ; 99(23): e20543, 2020 Jun 05.
Artigo em Inglês | MEDLINE | ID: mdl-32502015

RESUMO

An axial-volume scan with adaptive statistical iterative reconstruction-V (ASIR-V) is newly developed. Our goal was to identify the influence of axial-volume scan and ASIR-V on accuracy of automated nodule volumetry.An "adult' chest phantom containing various nodules was scanned using both helical and axial-volume modes at different dose settings using 256-slice CT. All CT scans were reconstructed using 30% and 50% blending of ASIR-V and filtered back projection. Automated nodule volumetry was performed using commercial software. The image noise, contrast-to-noise ratio (CNR), and signal-to-noise ratio (SNR) were measured.The axial-volume scan reduced radiation dose by 19.7% compared with helical scan at all radiation dose settings without affecting the accuracy of nodule volumetric measurement (P = .375). Image noise, CNR, and SNR were not significantly different between two scan modes (all, P > .05).The use of axial-volume scan with ASIR-V achieved effective radiation dose reduction while preserving the accuracy of nodule volumetry.


Assuntos
Nódulos Pulmonares Múltiplos/diagnóstico por imagem , Imagens de Fantasmas , Nódulo Pulmonar Solitário/diagnóstico por imagem , Algoritmos , Humanos , Doses de Radiação , Interpretação de Imagem Radiográfica Assistida por Computador , Razão Sinal-Ruído , Tomografia Computadorizada Espiral , Tomografia Computadorizada por Raios X
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