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3.
Radiol Med ; 125(1): 24-30, 2020 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-31531810

RESUMO

PURPOSE: The increasing number of computed tomography (CT) performed allows the more frequent identification of small, solid pulmonary nodules or ground-glass opacities. Video-assisted thoracic surgery (VATS) represents the standard in most lung resections. However, since VATS limit is the digital palpation of the lung parenchyma, many techniques of nodule localization were developed. The aim of this study was to determine the feasibility and safety of CT-guided microcoil insertion followed by uniportal VATS wedge resection (WR). MATERIALS AND METHODS: Retrospective study in a single institution, including patients undergone CT-guided microcoil insertion prior to uniportal VATS resection between May 2015 and December 2018. The lesion was identified using fluoroscopy. RESULTS: Forty-six consecutive patients were enrolled (22 male and 24 female). On CT: 5 cases of GGO, 2 cases of semisolid nodules, 39 cases of solid nodules. The median pathologic tumor size was 1.21 cm. Neither conversion to thoracotomy nor microcoil dislodgement was recorded. All patients underwent uniportal VATS WR (9/46 underwent completion lobectomy after frozen section). WR median time was 105 min (range 50-150 min). No patients required intraoperative re-resection for positive margins. After radiological procedure, 1 case of hematoma and 2 cases of pneumothorax were recorded. Four complications occurred in the postoperative period. The mean duration of chest drain and length of stay were 2.9 and 4.6 days, respectively. CONCLUSIONS: CT-guided microcoil insertion followed by uniportal VATS resection was a safe and feasible procedure having a minimal associated complications rate and offering surgeons the ease of localization of small intrapulmonary nodules.


Assuntos
Marcadores Fiduciais , Nódulos Pulmonares Múltiplos/diagnóstico por imagem , Nódulos Pulmonares Múltiplos/cirurgia , Radiografia Intervencionista/métodos , Cirurgia Torácica Vídeoassistida , Adulto , Idoso , Idoso de 80 Anos ou mais , Estudos de Viabilidade , Feminino , Hematoma/etiologia , Humanos , Masculino , Pessoa de Meia-Idade , Nódulos Pulmonares Múltiplos/patologia , Duração da Cirurgia , Pneumotórax/etiologia , Complicações Pós-Operatórias/etiologia , Estudos Retrospectivos , Cirurgia Torácica Vídeoassistida/efeitos adversos , Adulto Jovem
5.
J Cancer Res Clin Oncol ; 146(1): 153-185, 2020 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-31786740

RESUMO

PURPOSE: Lung cancer is the commonest cause of cancer deaths worldwide, and its mortality can be reduced significantly by performing early diagnosis and screening. Since the 1960s, driven by the pressing needs to accurately and effectively interpret the massive volume of chest images generated daily, computer-assisted diagnosis of pulmonary nodule has opened up new opportunities to relax the limitation from physicians' subjectivity, experiences and fatigue. And the fair access to the reliable and affordable computer-assisted diagnosis will fight the inequalities in incidence and mortality between populations. It has been witnessed that significant and remarkable advances have been achieved since the 1980s, and consistent endeavors have been exerted to deal with the grand challenges on how to accurately detect the pulmonary nodules with high sensitivity at low false-positive rate as well as on how to precisely differentiate between benign and malignant nodules. There is a lack of comprehensive examination of the techniques' development which is evolving the pulmonary nodules diagnosis from classical approaches to machine learning-assisted decision support. The main goal of this investigation is to provide a comprehensive state-of-the-art review of the computer-assisted nodules detection and benign-malignant classification techniques developed over three decades, which have evolved from the complicated ad hoc analysis pipeline of conventional approaches to the simplified seamlessly integrated deep learning techniques. This review also identifies challenges and highlights opportunities for future work in learning models, learning algorithms and enhancement schemes for bridging current state to future prospect and satisfying future demand. CONCLUSION: It is the first literature review of the past 30 years' development in computer-assisted diagnosis of lung nodules. The challenges indentified and the research opportunities highlighted in this survey are significant for bridging current state to future prospect and satisfying future demand. The values of multifaceted driving forces and multidisciplinary researches are acknowledged that will make the computer-assisted diagnosis of pulmonary nodules enter into the main stream of clinical medicine and raise the state-of-the-art clinical applications as well as increase both welfares of physicians and patients. We firmly hold the vision that fair access to the reliable, faithful, and affordable computer-assisted diagnosis for early cancer diagnosis would fight the inequalities in incidence and mortality between populations, and save more lives.


Assuntos
Aprendizado Profundo , Neoplasias Pulmonares/diagnóstico , Nódulos Pulmonares Múltiplos/diagnóstico , Algoritmos , Técnicas de Apoio para a Decisão , Humanos , Processamento de Imagem Assistida por Computador , Neoplasias Pulmonares/diagnóstico por imagem , Nódulos Pulmonares Múltiplos/diagnóstico por imagem , Tomografia por Emissão de Pósitrons , Tomografia Computadorizada por Raios X
6.
Int J Surg ; 71: 49-55, 2019 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-31521836

RESUMO

BACKGROUND: Localizing small pulmonary nodules (SPNs) is a challenge during thoracoscopic resection, but preoperative computed tomography (CT)-guided localization using either cyanoacrylate or hookwire can be helpful. This study compared the safety, efficiency, and operability of the two techniques. METHODS: From September 2013 to November 2018, 269 patients (269 SPNs) who underwent preoperative CT-guided SPN localization were enrolled. A propensity-matched analysis, incorporating 13 variables, was performed to control potential selection bias. RESULTS: All the patients were divided into two groups: CT-guided cyanoacrylate localization group (Group C, n = 149) and CT-guided hookwire localization group (Group H, n = 120). Eighty-six patients were propensity-matched in each group. All SPNs were successfully removed thoracoscopically, and no conversion was required. Localization-related complications in the two groups were similar, including intrapulmonary focal hemorrhage (p = 0.823), pneumothorax (p = 1.000), or hemoptysis (p = 0.121). For pain assessment and management, the cyanoacrylate localization saw a lower pain score (p < 0.001) and less morphine use (p < 0.001). In Group H, the localization took a significantly longer time (p < 0.001). Covering only the patients in Group C, the sub-analysis found that cyanoacrylate localization on the day before surgery did not compromise the accuracy of intraoperative targeting or increase the incidence of complications, compared with the localization on the day of surgery (all p > 0.05). CONCLUSION: Compared to hookwire localization, CT-guided cyanoacrylate localization decreased pain and morphine use and allowed flexible surgical schedules, suggestive of its preferability for the resection of SPNs.


Assuntos
Cianoacrilatos , Neoplasias Pulmonares/diagnóstico por imagem , Nódulos Pulmonares Múltiplos/diagnóstico por imagem , Dor Processual/epidemiologia , Instrumentos Cirúrgicos , Tomografia Computadorizada por Raios X/métodos , Idoso , Estudos de Coortes , Feminino , Humanos , Neoplasias Pulmonares/cirurgia , Masculino , Pessoa de Meia-Idade , Nódulos Pulmonares Múltiplos/cirurgia , Medição da Dor , Dor Processual/etiologia , Pontuação de Propensão , Cirurgia Torácica Vídeoassistida/métodos , Tomografia Computadorizada por Raios X/efeitos adversos
7.
Eur J Radiol ; 119: 108652, 2019 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-31521879

RESUMO

PURPOSE: To evaluate the clinical value of ultralow-dose CT (ULDCT) with adaptive statistical iterative reconstruction-V (ASiR-V) in the detection of pulmonary nodules in a Chinese population. METHOD: One hundred eighty-eight patients (16.41 ≤ BMI ≤ 29.87 kg/m2) with pulmonary nodules detected on low-dose chest CT (LDCT) underwent local ULDCT at the center of the chosen nodule with a scan length of 3 cm. LDCT was performed using the Assist kV (120/100 kV)/Smart mA mode and at 120 kV/2.8 mAs for ULDCT. After scanning, CT images were reconstructed with ASiR-V 50%. For both scans, nodule diameters were measured and reference standards were established for the presence and types of lung nodules found on LDCT. The sensitivity of ULDCT was compared against the standard, and logistic regression analysis was used to determine the independent predictors for nodule detection. RESULTS: Compared with LDCT (0.93 ±â€¯0.32 mSv), a 89.7% dose decrease was seen with ULDCT, for which the calculated effective dose was 0.096 ±â€¯0.006 mSv (P < 0.001). LDCT showed 188 nodules, including 123 solid and 65 subsolid nodules. The overall sensitivity for nodule detection in ULDCT was 90.4% (170/188), and 98.2% (54/55) for nodules ≥ 6 mm. In multivariate analysis, nodule types and diameters were independent predictors of sensitivity (P < 0.05). However, patients' BMI had no effect on nodule detection (P > 0.05). CONCLUSIONS: ULDCT can be used in the management of pulmonary nodules for people with BMI ≤ 30 kg/m2 at 10% radiation dose of LDCT.


Assuntos
Neoplasias Pulmonares/diagnóstico por imagem , Nódulos Pulmonares Múltiplos/diagnóstico por imagem , Tomografia Computadorizada por Raios X/métodos , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Algoritmos , Índice de Massa Corporal , Estudos de Viabilidade , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Análise Multivariada , Doses de Radiação , Interpretação de Imagem Radiográfica Assistida por Computador/métodos , Padrões de Referência , Adulto Jovem
8.
BMJ Case Rep ; 12(9)2019 Sep 05.
Artigo em Inglês | MEDLINE | ID: mdl-31492732

RESUMO

Parathyroid carcinoma is the rarest endocrine malignancy. Definitive diagnosis is challenging as it is difficult to distinguish malignant from benign disease. A 71-year-old man presented with weight loss and hypercalcaemia. CT scans revealed multiple lung nodules and lytic bone lesions that were consistent with metastatic dissemination. Technetium-99m-sestamibi-single-photon emission computed tomography scan showed an abnormal uptake in the right thyroid lobe. Fine-needle aspiration (FNA) was performed on three occasions. The patient underwent parathyroidectomy with ipsilateral hemithyroidectomy without postoperative complications. Microscopic examination showed a parathyroid neoplasm with fibrosis and intravascular tumour on a background of unremarkable thyroid parenchyma. This resulted in an initial impression of parathyroid carcinoma. Further review by two independent pathologists provided a final diagnosis of oncocytic parathyroid adenoma. This case highlights the subjectivity and interobserver variation with endocrine histological examination. FNA can induce changes that mimic parathyroid carcinoma on histology. An index of suspicion for benign parathyroid adenomas should be maintained.


Assuntos
Adenoma Oxífilo/diagnóstico , Hiperparatireoidismo Primário/diagnóstico , Nódulos Pulmonares Múltiplos/diagnóstico por imagem , Neoplasias das Paratireoides/diagnóstico , Adenoma Oxífilo/patologia , Adenoma Oxífilo/cirurgia , Idoso , Biópsia por Agulha Fina , Carcinoma/secundário , Diagnóstico Diferencial , Humanos , Hiperparatireoidismo Primário/cirurgia , Neoplasias Pulmonares/patologia , Masculino , Esvaziamento Cervical , Metástase Neoplásica , Neoplasias das Paratireoides/patologia , Neoplasias das Paratireoides/secundário , Neoplasias das Paratireoides/cirurgia , Paratireoidectomia , Compostos Radiofarmacêuticos , Tecnécio Tc 99m Sestamibi , Tireoidectomia , Tomografia Computadorizada de Emissão de Fóton Único , Tomografia Computadorizada por Raios X , Ultrassonografia
9.
J Comput Assist Tomogr ; 43(6): 926-930, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31453975

RESUMO

OBJECTIVE: To explore the exposure parameters with minimized radiation dose for accurate pulmonary nodule volumetry using low-dose computed tomography (LDCT). METHODS: An anthropomorphic chest phantom with 11 pulmonary nodules (6 solid nodules and 5 ground-glass opacities) was scanned using 256-slice multidetector computed tomography scanner at various tube voltage and current (combinations of 80, 100 and 120 kV with 10 to 30 mAs). Raw data sets were reconstructed using the hybrid iterative reconstruction method and nodule volume was calculated by a semiautomatic software. The absolute percentage error (APE) of nodule volume relating to the reference acquisition and contrast-to-noise ratio was measured. RESULTS: Nodule characteristic and tube voltage (P < 0.0001) as well as the interaction between nodule characteristic and tube voltage (P = 0.0026) contributed significantly to the mean difference of APE, while tube current did not (P = 0.21). Post hoc analysis revealed no significant difference was found between the APE at 100 kV and 120 kV in both solid nodules (2.3 ± 0.4% vs 1.8 ± 0.6%, P = 0.14) and ground-glass opacities (6.0 ± 0.5% vs 4.9 ± 0.6%, P = 0.11). Exploratory analyses further showed that the APE at 100 kV with 10 mAs did not differ from that at 120 kV with 30 mAs in both solid nodules (2.5 ± 0.5% vs 1.7 ± 0.3%, P = 0.025, corrected P = 0.20) and ground-glass opacities (6.4 ± 0.4% vs 4.8 ± 1.0%, P = 0.0084, corrected P = 0.068). CONCLUSIONS: In our study, the exposure parameters with minimized radiation dose for accurate pulmonary nodule volumetry were found at 100 kV with 10 mAs, and the estimated effect radiation dose was as low as 0.2 mSv, suggesting the feasibility of further reducing radiation dose by decreasing tube voltage and current in LDCT lung screening.


Assuntos
Tomografia Computadorizada Multidetectores/instrumentação , Nódulos Pulmonares Múltiplos/diagnóstico por imagem , Nódulo Pulmonar Solitário/diagnóstico por imagem , Humanos , Imagens de Fantasmas , Intensificação de Imagem Radiográfica , Interpretação de Imagem Radiográfica Assistida por Computador/métodos , Sensibilidade e Especificidade
10.
J Cardiothorac Surg ; 14(1): 149, 2019 Aug 19.
Artigo em Inglês | MEDLINE | ID: mdl-31426812

RESUMO

OBJECTIVES: The study aimed to retrospectively evaluate the success rate, utility, practicality and results of pre-operative CT (computed tomography)-guided semi-rigid single hook-wire placement and the pathology results of small pulmonary nodules (SPN). MATERIALS AND METHODS: Seventy-four patients with 81 small pulmonary nodules underwent CT-guided semi-rigid single hook wire localization consecutively between 2016 and 2017 were reviewed. VATS (video-assisted thoracoscopic surgery) resection of lung tissue containing each pulmonary nodule and were performed in the direction of hook wire. The success rate and utility of the localization, hook wire related complications, the histopathology of SPN are analyzed. RESULTS: The semi-rigid hook wire was performed successfully in all 81 small pulmonary nodules within mean time of 10 min (8-13 min, SD: 1.58 min). Compared with solid nodules, GGOs (ground-glass opacity) were more frequently malignant (p < 0.05), with an OR (odds ratio) 8.59 (95%CI, 0.967, 412.845). Of the pure GGOs, 9 (25%) nodules were classified as AIS, 10 (27.8%) nodules were classified as MIA and 22 (57.9%) of the mGGOs were lung cancer. According to multivariate analysis, the malignant hazard was as high as 6.533-fold higher in nodules with a size larger than 10 mm compared with those smaller than 10 mm. GGOs with tiny blood vessels showed a statistically significant correlation with malignancy. Surprisingly, no statistically significant difference in the incidence of lung cancer in age. No major complication occurred. CONCLUSIONS: Preoperative localization of small pulmonary nodules using semi-rigid single hook wire was found to be practical and safe, which allows for proper diagnosis. Incidental small pulmonary nodule, especially GGO larger than 10 mm needs to be taken seriously.


Assuntos
Marcadores Fiduciais , Neoplasias Pulmonares/cirurgia , Nódulos Pulmonares Múltiplos/cirurgia , Nódulo Pulmonar Solitário/cirurgia , Tomografia Computadorizada por Raios X , Adulto , Idoso , Feminino , Humanos , Neoplasias Pulmonares/diagnóstico por imagem , Neoplasias Pulmonares/patologia , Masculino , Pessoa de Meia-Idade , Nódulos Pulmonares Múltiplos/diagnóstico por imagem , Nódulos Pulmonares Múltiplos/patologia , Período Pré-Operatório , Estudos Retrospectivos , Nódulo Pulmonar Solitário/diagnóstico por imagem , Nódulo Pulmonar Solitário/patologia , Cirurgia Torácica Vídeoassistida , Carga Tumoral , Adulto Jovem
11.
Br J Radiol ; 92(1103): 20180909, 2019 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-31469289

RESUMO

OBJECTIVE: To evaluate the clinical value of low-dose chest CT combined with the new generation adaptive statistical iterative reconstruction (ASIR-V) algorithm in the diagnosis of pulmonary nodule. METHODS: 30 patients with pulmonary nodules underwent chest CT using Revolution CT. The patients were first scanned with standard-dose at a noise index (NI) of 14, and the images were reconstructed with filtered back projection (FBP) algorithm. If pulmonary nodules were found, a low-dose targeted scan, with NI of 24, was performed localized on the nodules, and the images were reconstructed with 60% ASIR-V. The detection rate of pulmonary nodules in the two scanning modes was recorded. The size of nodules, CT value and standard deviation of nodules were measured. The signal-to-noise ratio and contrast-to-noise ratio were also calculated. Two experienced radiologists used a 5-point method to score the image quality. The volumetric CT dose index, and dose-length product were recorded and the effective dose (ED) was calculated of the two scanning modes. RESULTS: Volumetric CT dose index (ED) of the standard-dose scan covering the entire lungs was 7.29 ± 2.38 mGy (3.52 ± 1.09 mSv), and that of low-dose targeted scan was 2.56 ± 1.87 mGy (0.51 ± 0.32 mSv). However, the ED of the virtual low-dose scan for the entire lungs was 1.44 ± 0.15 mSv, which would mean a dose reduction of 59.1% compared with the standard-dose scan. 85 of the 87 pulmonary nodules were detected in the low-dose targeted scan, with 2 of the ground-glass density nodules with size less than 1 cm missed, resulting in 97.7% overall detection rate. There was no difference between the low-dose ASIR-V images and standard-dose FBP images for the size (1.49 ± 0.74 cm vs 1.48 ± 0.75 cm), CT value [33.02 ± 1.95 Hounsfield unit (HU) vs 34.6 ± 3.07 HU], standard deviation (27.64 ± 14.42 HU vs 30.38 ± 20.04 HU), signal-to-noise ratio (1.44 ± 0.88 vs 1.43 ± 1.31) and contrast-to-noise ratio (38.95 ± 18.43 vs 38.23 ± 14.99) of nodules (all p > 0.05). There was no difference in the subjective scores between the two scanning modes. CONCLUSION: The low-dose CT scan combined with ASIR-V algorithm is of comparable value in the detection and the display of pulmonary nodules when compared with the FBP images obtained by standard-dose scan. ADVANCES IN KNOWLEDGE: This is a clinical study to evaluate the clinical value of pulmonary nodules using ASIR-V algorithm in the same patients in the low-dose chest CT scans. It suggests that ASIR-V provides similar image quality and detection rate for pulmonary nodules at much reduced radiation dose.


Assuntos
Nódulos Pulmonares Múltiplos/diagnóstico por imagem , Tomografia Computadorizada por Raios X/métodos , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Algoritmos , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Nódulos Pulmonares Múltiplos/patologia , Doses de Radiação , Interpretação de Imagem Radiográfica Assistida por Computador , Razão Sinal-Ruído , Adulto Jovem
12.
J Thorac Cardiovasc Surg ; 157(5): 2061-2069, 2019 05.
Artigo em Inglês | MEDLINE | ID: mdl-31288365

RESUMO

BACKGROUND: Complete pulmonary metastasectomy for sarcoma metastases provides patients an opportunity for long-term survival and possible cure. Intraoperative localization of preoperatively identified metastases and identification of occult lesions can be challenging. In this trial, we evaluated the efficacy of near-infrared (NIR) intraoperative imaging using second window indocyanine green during metastasectomy to identify known metastases and to detect occult nodules. METHODS: Thirty patients with pulmonary nodules suspicious for sarcoma metastases were enrolled in an open-label, feasibility study (NCT02280954). All patients received intravenous indocyanine green (5 mg/kg) 24 hours before metastasectomy. Patients 1 through 10 (cohort 1) underwent metastasectomy via thoracotomy to assess fluorescence patterns of nodules detected by traditional methods (preoperative imaging and intraoperative visualization/bimanual palpation). After confirming reliability within cohort 1, patients 11 through 30 (cohort 2) underwent video-assisted thoracic surgery metastasectomy with NIR imaging. RESULTS: In cohort 1, 14 out of 16 preoperatively identified pulmonary metastases (87.5%) displayed tumor fluorescence. Nonfluorescent metastases were deeper than fluorescent metastases (2.1 cm vs 1.3 cm; P = .03). Five out of 5 metastases identified during thoracotomy displayed fluorescence. NIR imaging identified 3 additional occult lesions in this cohort. In cohort 2, 33 out of 37 known pulmonary metastases (89.1%) displayed fluorescence. Nonfluorescent tumors were deeper than 2.0 cm (P = .007). NIR imaging identified 24 additional occult lesions. Of 24 occult lesions, 21 (87.5%) were confirmed metastases and the remaining 3 nodules were lymphoid aggregates. CONCLUSIONS: NIR intraoperative imaging with indocyanine green (5 mg/kg and 24 hours before surgery) localizes known sarcoma pulmonary metastases and identifies otherwise occult lesions. This approach may be a useful intraoperative adjunct to improve metastasectomy.


Assuntos
Neoplasias Pulmonares/cirurgia , Metastasectomia/métodos , Nódulos Pulmonares Múltiplos/cirurgia , Imagem Óptica/métodos , Pneumonectomia , Sarcoma/cirurgia , Nódulo Pulmonar Solitário/cirurgia , Espectroscopia de Luz Próxima ao Infravermelho , Cirurgia Torácica Vídeoassistida , Toracotomia , Adulto , Idoso , Estudos de Viabilidade , Feminino , Corantes Fluorescentes/administração & dosagem , Humanos , Verde de Indocianina/administração & dosagem , Neoplasias Pulmonares/diagnóstico por imagem , Neoplasias Pulmonares/secundário , Masculino , Metastasectomia/efeitos adversos , Pessoa de Meia-Idade , Nódulos Pulmonares Múltiplos/diagnóstico por imagem , Nódulos Pulmonares Múltiplos/secundário , Pneumonectomia/efeitos adversos , Valor Preditivo dos Testes , Reprodutibilidade dos Testes , Sarcoma/diagnóstico por imagem , Sarcoma/secundário , Nódulo Pulmonar Solitário/diagnóstico por imagem , Nódulo Pulmonar Solitário/secundário , Cirurgia Torácica Vídeoassistida/efeitos adversos , Toracotomia/efeitos adversos , Fatores de Tempo , Resultado do Tratamento , Carga Tumoral , Adulto Jovem
13.
Intern Med ; 58(21): 3149-3152, 2019 Nov 01.
Artigo em Inglês | MEDLINE | ID: mdl-31327818

RESUMO

Chest computed tomography (CT) findings of minute pulmonary meningothelial-like nodules (MPMNs) usually show tiny nodules (2-5 mm in diameter) of ground-glass attenuation. However, diffuse, thin-walled cavities have rarely been reported. We herein report a 56-year-old woman with MPMNs showing diffuse, thin-walled cystic lesions on a thin-section chest CT scan. Clinicians need to be aware of the imaging characteristics of this conditions to guide appropriate management of lung diseases, as these CT findings may resemble certain metastatic lung neoplasias and primary adenocarcinoma of the lung.


Assuntos
Neoplasias Pulmonares/patologia , Pulmão/patologia , Nódulos Pulmonares Múltiplos/patologia , Diagnóstico Diferencial , Feminino , Humanos , Pulmão/diagnóstico por imagem , Neoplasias Pulmonares/diagnóstico por imagem , Masculino , Pessoa de Meia-Idade , Nódulos Pulmonares Múltiplos/diagnóstico por imagem , Tomografia Computadorizada por Raios X
14.
J Comput Assist Tomogr ; 43(5): 817-824, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31343995

RESUMO

OBJECTIVE: The aim of this study was to investigate the differentiation of computed tomography (CT)-based entropy parameters between minimally invasive adenocarcinoma (MIA) and invasive adenocarcinoma (IAC) lesions appearing as pulmonary subsolid nodules (SSNs). METHODS: This study was approved by the institutional review board in our hospital. From July 2015 to November 2018, 186 consecutive patients with solitary peripheral pulmonary SSNs that were pathologically confirmed as pulmonary adenocarcinomas (74 MIA and 112 IAC lesions) were included and subdivided into the training data set and the validation data set. Chest CT scans without contrast enhancement were performed in all patients preoperatively. The subjective CT features of the SSNs were reviewed and compared between the MIA and IAC groups. Each SSN was semisegmented with our in-house software, and entropy-related parameters were quantitatively extracted using another in-house software developed in the MATLAB platform. Logistic regression analysis and receiver operating characteristic analysis were performed to evaluate the diagnostic performances. Three diagnostic models including subjective model, entropy model, and combined model were built and analyzed using area under the curve (AUC) analysis. RESULTS: There were 119 nonsolid nodules and 67 part-solid nodules. Significant differences were found in the subjective CT features among nodule type, lesion size, lobulated shape, and irregular margin between the MIA and IAC groups. Multivariate analysis revealed that part-solid type and lobulated shape were significant independent factors for IAC (P < 0.0001 and P < 0.0001, respectively). Three entropy parameters including Entropy-0.8, Entropy-2.0-32, and Entropy-2.0-64 were identified as independent risk factors for the differentiation of MIA and IAC lesions. The median entropy model value of the MIA group was 0.266 (range, 0.174-0.590), which was significantly lower than the IAC group with value 0.815 (range, 0.623-0.901) (P < 0.0001). Multivariate analysis revealed that the combined model had an excellent diagnostic performance with sensitivity of 88.2%, specificity of 73.0%, and accuracy of 82.1%. The AUC value of the combined model was significantly higher (AUC, 0.869) than that of the subjective model (AUC, 0.809) or the entropy model alone (AUC, 0.836) (P < 0.0001). CONCLUSIONS: The CT-based entropy parameters could help assess the aggressiveness of pulmonary adenocarcinoma via quantitative analysis of intratumoral heterogeneity. The MIA can be differentiated from IAC accurately by using entropy-related parameters in peripheral pulmonary SSNs.


Assuntos
Adenocarcinoma/diagnóstico por imagem , Neoplasias Pulmonares/diagnóstico por imagem , Nódulos Pulmonares Múltiplos/diagnóstico por imagem , Tomografia Computadorizada por Raios X/métodos , Adenocarcinoma/patologia , Adulto , Idoso , Diagnóstico Diferencial , Entropia , Feminino , Humanos , Neoplasias Pulmonares/patologia , Masculino , Pessoa de Meia-Idade , Nódulos Pulmonares Múltiplos/patologia , Invasividade Neoplásica/diagnóstico por imagem , Invasividade Neoplásica/patologia , Interpretação de Imagem Radiográfica Assistida por Computador , Estudos Retrospectivos
15.
AJR Am J Roentgenol ; 213(4): W162-W170, 2019 10.
Artigo em Inglês | MEDLINE | ID: mdl-31216199

RESUMO

OBJECTIVE. The purpose of this study is to comprehensively investigate the role of multiple features seen on thin-section CT (TSCT) in the differential diagnosis of ground-glass nodules (GGNs) measuring 5-10 mm in diameter as invasive adenocarcinoma (IAC). MATERIALS AND METHODS. The TSCT features of 313 surgically diagnosed GGNs from 288 patients were retrospectively reviewed. A logistic regression model was applied, and the AUC values for the model and the size and attenuation of the lesions were compared using ROC curve analysis. RESULTS. A total of 247 lung adenocarcinomas in situ (AISs) and minimally invasive adenocarcinomas (MIAs) (hereafter referred to as the AIS-MIA group) and 66 invasive adenocarcinomas (IACs) were identified. Compared with the AIS-MIA group, the IAC groups were significantly larger in size and had higher attenuation values, a higher frequency of mixed GGNs (all p < 0.001), bubblelike appearance, spiculation, pleural indentation, different locations, and a lower frequency of clear tumor-lung interface (all p < 0.05). The logistic model included size and attenuation (both p < 0.001; odds ratio [OR], 1.872 and 1.009, respectively) as well as tumor-lung interface (p = 0.001; OR, 0.242), bubblelike appearance (p < 0.05; OR, 2.205), and type of nodule. The AUC value for the logistic model was 0.847 (sensitivity, 80.3%; specificity, 81.0%) and was significantly higher than that for size or attenuation (both p < 0.01). CONCLUSION. Radiologic features could help in the differential diagnosis of a GGN that was 5-10 mm in diameter as IAC versus AIS or MIA. GGNs larger than 8.12 mm and with attenuation greater than -449.52 HU were more likely to be IAC.


Assuntos
Adenocarcinoma/diagnóstico por imagem , Neoplasias Pulmonares/diagnóstico por imagem , Nódulos Pulmonares Múltiplos/diagnóstico por imagem , Tomografia Computadorizada por Raios X/métodos , Adenocarcinoma/patologia , Adenocarcinoma/cirurgia , Diagnóstico Diferencial , Feminino , Humanos , Neoplasias Pulmonares/patologia , Neoplasias Pulmonares/cirurgia , Masculino , Pessoa de Meia-Idade , Nódulos Pulmonares Múltiplos/patologia , Nódulos Pulmonares Múltiplos/cirurgia , Invasividade Neoplásica , Estudos Retrospectivos
17.
Zhongguo Fei Ai Za Zhi ; 22(6): 336-340, 2019 Jun 20.
Artigo em Chinês | MEDLINE | ID: mdl-31196366

RESUMO

BACKGROUND: The detection of pulmonary nodules is a key step to achieving the early diagnosis and therapy of lung cancer. Deep learning based Artificial intelligence (AI) presents as the state of the art in the area of nodule detection, however, a validation with clinical data is necessary for further application. Therefore, the aim of this study is to evaluate the performance of AI in the detection of malignant and non-calcified nodules in chest CT. METHODS: Two hundred chest computed tomography (CT) data were randomly selected from a self-built nodule database from Tianjin Medical University General Hospital. Both the pathology confirmed lung cancers and the nodules in the process of follow-up were included. All CTs were processed by AI and the results were compared with that of radiologists retrieved from the original medical reports. The ground truths were further determined by two experienced radiologists. The size and characteristics of the nodules were evaluated as well. The sensitivity and false positive rate were used to evaluate the effectiveness of AI and radiologists in detecting nodules. The McNemar test was used to determine whether there was a significant difference. RESULTS: A total of 889 non-calcified nodules were determined by experts on chest CT, including 133 lung cancers. Of them, 442 nodules were less than 5 mm. The cancer detection rates of AI and radiologists are 100%. The sensitivity of AI on nodule detection was significantly higher than that of radiologists (99.1% vs 43%, P<0.001). The false-positive rate of AI was 4.9 per CT and decreased to 1.5 when nodules less than 5 mm were excluded. CONCLUSIONS: AI achieves the detection of all malignancies and improve the sensitivity of pulmonary nodules detection beyond radiologists, with a low false positive rate after excluding small nodules.


Assuntos
Inteligência Artificial , Aprendizado Profundo , Neoplasias Pulmonares/diagnóstico por imagem , Nódulos Pulmonares Múltiplos/diagnóstico por imagem , Humanos , Neoplasias Pulmonares/diagnóstico , Nódulos Pulmonares Múltiplos/diagnóstico , Tomografia Computadorizada por Raios X
18.
Zhongguo Fei Ai Za Zhi ; 22(6): 349-354, 2019 Jun 20.
Artigo em Chinês | MEDLINE | ID: mdl-31196368

RESUMO

BACKGROUND: Preoperative computed tomography (CT) guided microcoil localization is a common method for small lung nodules before video-assisted thoracoscopic surgery (VATS). However, this method still has some limitation such as complicated operation and slight complications. We have optimized the original method. The purpose of this study was to investigate the clinical value of this optimized method. METHODS: 35 pulmonary nodules from 31 patients between September 2018 and January 2019 were localized by the optimized method before VATS. The success rate, complications, pathological results and localization operations related data were statistically analyzed. RESULTS: The success rate of localization was 97.1%, and the success rate of VATS removal was 100%. The average operation time was 10.1 min (5 min-31 min), and the average time required for resection of lesions was 38.2 min (10 min-100 min). During the surgery, the microcoil of one patient was found to be dislocated and retracted into the chest wall. A puncture needle was inserted intolung tissue from the chest wall puncture point after the lung was inflated, and then the pulmonary nodule were successfully located and removed. A minor pneumothorax occurred in 3 patients, but no closed drainage was needed. Three patients developed intrapulmonary hematoma. The pathological results of 35 pulmonary nodules included 15 well-differentiated adenocarcinoma, 7 carcinoma in situ, 5 microinvasive adenocarcinoma, 4 atypical adenomatoid hyperplasia, 2 intrapulmonary lymph node hyperplasia, 2 inflammatory nodules. CONCLUSIONS: For small pulmonary nodules requiring thoracoscopic surgery, the optimized computed tomography-guided pulmonary nodule microcoil localization technique is convenient, safe and effective, and worthy of promotion to use.


Assuntos
Neoplasias Pulmonares/diagnóstico por imagem , Nódulos Pulmonares Múltiplos/diagnóstico por imagem , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Feminino , Humanos , Neoplasias Pulmonares/cirurgia , Linfonodos/diagnóstico por imagem , Linfonodos/cirurgia , Masculino , Pessoa de Meia-Idade , Nódulos Pulmonares Múltiplos/cirurgia , Cirurgia Torácica Vídeoassistida , Tomografia Computadorizada por Raios X , Adulto Jovem
20.
AJR Am J Roentgenol ; 213(3): W114-W122, 2019 09.
Artigo em Inglês | MEDLINE | ID: mdl-31082273

RESUMO

OBJECTIVE. The objective of our study was to investigate the potentials of enhanced dual-source dual-energy CT (DECT) and three-planar measurements for differentiating invasive pulmonary adenocarcinomas (IPAs) from preinvasive lesions appearing as pure ground-glass nodules (pGGNs). MATERIALS AND METHODS. Thirty-nine patients with 53 pGGNs who underwent enhanced dual-source DECT were included in this retrospective study. All pGGNs were pathologically confirmed and categorized into two groups: preinvasive lesions or IPAs. The traditional CT features of the pGGNs were evaluated on unenhanced images. Quantitative parameters were measured on iodine-enhanced images of dual-source DECT in three planes, and both intra- and interobserver reproducibility analyses were performed to assess the measurement reproducibility of quantitative parameters. To identify significant factors for differentiating IPAs from preinvasive lesions, we performed logistic regression analysis and ROC curve analysis. RESULTS. For traditional CT features, only lesion size and unenhanced CT attenuation value showed significant differences between preinvasive lesions and IPAs (p < 0.05). Preinvasive lesions and IPAs exhibited significant differences in attenuation on virtual images, so-called "virtual HU" or "VHU," and the modified normalized iodine concentration (NIC) (p < 0.05), and both intra- and interobserver agreement for the quantitative measurements were excellent. Multivariate logistic regression analysis revealed that larger lesion size (adjusted odds ratio [OR], 3.65) and higher modified NIC (adjusted OR, 19.01) were significant differentiators of IPAs from preinvasive lesions (p < 0.05). ROC curve analysis revealed that modified NIC showed excellent performance (AUC, 0.924) and significantly higher performance than lesion size (AUC, 0.711) for differentiating IPAs from preinvasive lesions. CONCLUSION. In pGGNs, a lesion with a modified NIC value of more than 0.29 can be a very specific discriminator of IPAs from preinvasive lesions, and IPAs can be accurately and reliably differentiated from preinvasive lesions using enhanced dual-source DECT and three-planar measurements.


Assuntos
Adenocarcinoma/diagnóstico por imagem , Neoplasias Pulmonares/diagnóstico por imagem , Nódulos Pulmonares Múltiplos/diagnóstico por imagem , Invasividade Neoplásica/diagnóstico por imagem , Tomografia Computadorizada por Raios X/métodos , Adenocarcinoma/patologia , Idoso , Meios de Contraste , Diagnóstico Diferencial , Feminino , Humanos , Neoplasias Pulmonares/patologia , Masculino , Nódulos Pulmonares Múltiplos/patologia , Invasividade Neoplásica/patologia , Reprodutibilidade dos Testes , Estudos Retrospectivos
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