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1.
Respir Med ; 164: 105896, 2020 04.
Artigo em Inglês | MEDLINE | ID: mdl-32217287

RESUMO

INTRODUCTION: Light chain deposition disease (LCDD) rarely involves the lungs. We report clinical and radiologic findings of pulmonary LCDD. METHODS: We retrospectively identified patients with biopsy-proven pulmonary LCDD seen at Mayo Clinic (Rochester, Minnesota) from January 1997 through December 2018. Demographic, clinical, and imaging features were analyzed. RESULTS: We identified 10 patients with pulmonary LCDD (median age at diagnosis, 55 years; range, 39-77 years). Eight patients were women and 7 were never-smokers. Dyspnea (n = 3) and chest pain (n = 3) were the most common respiratory symptoms. Associated conditions included Sjögren syndrome (n = 6), sarcoidosis (n = 1), and limited scleroderma (n = 1). Eight patients had mucosa-associated lymphoid tissue (MALT) lymphoma. Among the 9 patients with chest computed tomography (CT) images, 8 (89%) had cysts. Cysts were predominantly distributed in the lower lung and were round or oval. All patients had multiple cysts (5 patients had 1-5 cysts, 3 had >20 cysts). The median diameter of the largest cyst was 18 mm (range, 5-68 mm). All 9 patients had solid nodules (3 had >10 nodules). Five patients had subsolid nodules. The median diameter of the largest solid nodules was 13 mm (range, 6-26 mm). Positron emission tomography-CT images were available for 8 patients. The median maximum standardized uptake value of the most avid pulmonary nodule was 2.2 (range, 1.9-6.0). Two patients died during a median follow-up of 2.3 years (range, 0.5-9.9 years). CONCLUSIONS: Pulmonary LCDD is characterized by cysts and nodules. The disease is associated with MALT lymphoma, especially in the setting of Sjögren syndrome.


Assuntos
Cadeias Leves de Imunoglobulina/metabolismo , Nódulos Pulmonares Múltiplos/metabolismo , Adulto , Idoso , Comorbidade , Cistos/epidemiologia , Feminino , Humanos , Pneumopatias/epidemiologia , Linfoma de Zona Marginal Tipo Células B/complicações , Masculino , Pessoa de Meia-Idade , Nódulos Pulmonares Múltiplos/diagnóstico por imagem , Nódulos Pulmonares Múltiplos/epidemiologia , Nódulos Pulmonares Múltiplos/patologia , Estudos Retrospectivos , Sarcoidose/epidemiologia , Esclerodermia Limitada/epidemiologia , Síndrome de Sjogren/epidemiologia
2.
Thorax ; 75(4): 306-312, 2020 04.
Artigo em Inglês | MEDLINE | ID: mdl-32139611

RESUMO

BACKGROUND: Estimation of the risk of malignancy in pulmonary nodules detected by CT is central in clinical management. The use of artificial intelligence (AI) offers an opportunity to improve risk prediction. Here we compare the performance of an AI algorithm, the lung cancer prediction convolutional neural network (LCP-CNN), with that of the Brock University model, recommended in UK guidelines. METHODS: A dataset of incidentally detected pulmonary nodules measuring 5-15 mm was collected retrospectively from three UK hospitals for use in a validation study. Ground truth diagnosis for each nodule was based on histology (required for any cancer), resolution, stability or (for pulmonary lymph nodes only) expert opinion. There were 1397 nodules in 1187 patients, of which 234 nodules in 229 (19.3%) patients were cancer. Model discrimination and performance statistics at predefined score thresholds were compared between the Brock model and the LCP-CNN. RESULTS: The area under the curve for LCP-CNN was 89.6% (95% CI 87.6 to 91.5), compared with 86.8% (95% CI 84.3 to 89.1) for the Brock model (p≤0.005). Using the LCP-CNN, we found that 24.5% of nodules scored below the lowest cancer nodule score, compared with 10.9% using the Brock score. Using the predefined thresholds, we found that the LCP-CNN gave one false negative (0.4% of cancers), whereas the Brock model gave six (2.5%), while specificity statistics were similar between the two models. CONCLUSION: The LCP-CNN score has better discrimination and allows a larger proportion of benign nodules to be identified without missing cancers than the Brock model. This has the potential to substantially reduce the proportion of surveillance CT scans required and thus save significant resources.


Assuntos
Inteligência Artificial , Transformação Celular Neoplásica/patologia , Neoplasias Pulmonares/patologia , Nódulos Pulmonares Múltiplos/patologia , Redes Neurais de Computação , Adulto , Idoso , Algoritmos , Área Sob a Curva , Estudos de Coortes , Bases de Dados Factuais , Detecção Precoce de Câncer/métodos , Feminino , Humanos , Incidência , Neoplasias Pulmonares/epidemiologia , Neoplasias Pulmonares/fisiopatologia , Masculino , Pessoa de Meia-Idade , Nódulos Pulmonares Múltiplos/epidemiologia , Nódulos Pulmonares Múltiplos/fisiopatologia , Invasividade Neoplásica/patologia , Estadiamento de Neoplasias , Valor Preditivo dos Testes , Prognóstico , Curva ROC , Estudos Retrospectivos , Medição de Risco
4.
Tuberk Toraks ; 67(3): 190-196, 2019 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-31709950

RESUMO

Introduction: Pulmonary nodules are common incidental findings on computed tomography (CT). In Turkey, there is no available data about the follow-up of the frequency of incidental nodules. Our aim is to assess the frequency and size distrubition of incidental pulmonary nodule in our country. Materials and Methods: Between January 2015 and December 2016, computed tomographies, taken of all outpatient and emergency department that recorded in the screening database were examined retrospectively. Nodules and their characteristics (number, size, density, localization) and relationship between age and gender were evaluated. Result: The age range of the cases was mean 58.99 ± 16.20 years, 256 (42.5%) were women and 347 (57.5%) were men. A total of 288 (48.25%) cases had 420 nodules. Solid nodule was present in 184 cases (30.5%). The number of cases with one solid nodule was 119 (64.7%). There were 124 solid nodules (55.36%) of ≥ 4-< 6 mm diameter, 64 solid nodules (28.57%) of ≥ 6-< 8 mm diameter and 36 solid nodules (16.07%) of ≥ 8 mm diameter. Nodule frequency increased statistically significantly with the age (p= 0.001). Conclusions: The frequency of incidental nodule was found higher than in our country than in developed countries.


Assuntos
Nódulo Pulmonar Solitário/diagnóstico por imagem , Nódulo Pulmonar Solitário/epidemiologia , Adulto , Idoso , Serviço Hospitalar de Emergência , Feminino , Humanos , Achados Incidentais , Neoplasias Pulmonares/diagnóstico por imagem , Neoplasias Pulmonares/epidemiologia , Masculino , Pessoa de Meia-Idade , Nódulos Pulmonares Múltiplos/epidemiologia , Estudos Retrospectivos , Tomografia Computadorizada por Raios X , Turquia/epidemiologia
5.
Diagn Interv Radiol ; 25(6): 435-441, 2019 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-31650972

RESUMO

PURPOSE: We aimed to evaluate the feasibility, accuracy, and complications of computed tomography (CT)-guided percutaneous transthoracic needle biopsy (PTNB) of cavitary lesions. METHODS: Consecutive PTNB procedures in an academic institution over a 4-year period were reviewed, 53 of which were performed on patients with cavitary lesions. The demographic data of patients, lesion characteristics, biopsy technique and complications, initial pathologic results, and final diagnosis were reviewed. A final diagnosis was established through surgical correlation, microbiology or clinico-radiologic follow-up for at least 18 months after biopsy. RESULTS: The overall accuracy of PTNB was 81%. In 33 patients (62%) the cavitary lesion was found to be malignant (23 lung cancers and 10 metastases). The sensitivity and specificity for malignancy was 91% and 100%, respectively. In 20 patients (38%) a benign etiology was established (16 infections and 4 noninfectious etiologies), with PTNB demonstrating a sensitivity of 81% and specificity of 100% for infection. Wall thickness at the biopsy site, lesion in lower lobe, and malignancy were significant independent risk factors for diagnostic success. Minor complications occurred in 28% of cases: 13 pneumothoraces (5 requiring chest tube), 1 small hemothorax, and 1 mild hemoptysis. A nonsignificant higher chest tube insertion rate was seen in cavities with a thinner wall. CONCLUSION: PTNB of cavitary lesions provides high accuracy, sensitivity, and specificity for both malignancy and infection and has an acceptable complication rate. Wall thickness at the biopsy site, lesion in lower lobe, and malignancy were significant independent risk factors for diagnostic success. Samples for microbiology should be obtained in all patients, especially in the absence of on-site cytology, due to the high prevalence of infection in cavitary lesions.


Assuntos
Biópsia por Agulha/efeitos adversos , Biópsia Guiada por Imagem/efeitos adversos , Pulmão/microbiologia , Pulmão/patologia , Idoso , Tubos Torácicos , Estudos de Viabilidade , Feminino , Hemoptise/etiologia , Hemotórax/etiologia , Humanos , Biópsia Guiada por Imagem/instrumentação , Neoplasias Pulmonares/epidemiologia , Neoplasias Pulmonares/microbiologia , Neoplasias Pulmonares/patologia , Masculino , Pessoa de Meia-Idade , Nódulos Pulmonares Múltiplos/epidemiologia , Nódulos Pulmonares Múltiplos/microbiologia , Nódulos Pulmonares Múltiplos/patologia , Metástase Neoplásica/patologia , Pneumotórax/etiologia , Pneumotórax/terapia , Prevalência , Estudos Retrospectivos , Fatores de Risco , Sensibilidade e Especificidade , Parede Torácica/patologia , Tomografia Computadorizada por Raios X/métodos
6.
Diagnosis (Berl) ; 6(4): 351-359, 2019 11 26.
Artigo em Inglês | MEDLINE | ID: mdl-31373897

RESUMO

Background Though incidental pulmonary nodules are common, rates of guideline-recommended surveillance and associations between surveillance and mortality are unclear. In this study, we describe adherence (categorized as complete, partial, late and none) to guideline-recommended surveillance among patients with incidental 5-8 mm pulmonary nodules and assess associations between adherence and mortality. Methods This was a retrospective cohort study of 551 patients (≥35 years) with incidental pulmonary nodules conducted from September 1, 2008 to December 31, 2016, in an integrated safety-net health network. Results Of the 551 patients, 156 (28%) had complete, 87 (16%) had partial, 93 (17%) had late and 215 (39%) had no documented surveillance. Patients were followed for a median of 5.2 years [interquartile range (IQR), 3.6-6.7 years] and 82 (15%) died during follow-up. Adjusted all-cause mortality rates ranged from 2.24 [95% confidence interval (CI), 1.24-3.25] deaths per 100 person-years for complete follow-up to 3.30 (95% CI, 2.36-4.23) for no follow-up. In multivariable models, there were no statistically significant associations between the levels of surveillance and mortality (p > 0.16 for each comparison with complete surveillance). Compared with complete surveillance, adjusted mortality rates were non-significantly increased by 0.45 deaths per 100 person-years (95% CI, -1.10 to 2.01) for partial, 0.55 (95% CI, -1.08 to 2.17) for late and 1.05 (95% CI, -0.35 to 2.45) for no surveillance. Conclusions Although guideline-recommended surveillance of small incidental pulmonary nodules was incomplete or absent in most patients, gaps in surveillance were not associated with statistically significant increases in mortality in a safety-net population.


Assuntos
Fidelidade a Diretrizes/normas , Neoplasias Pulmonares/diagnóstico por imagem , Nódulos Pulmonares Múltiplos/diagnóstico por imagem , Provedores de Redes de Segurança/métodos , Idoso , Grupos Étnicos , Feminino , Seguimentos , Fidelidade a Diretrizes/estatística & dados numéricos , Humanos , Achados Incidentais , Neoplasias Pulmonares/epidemiologia , Neoplasias Pulmonares/mortalidade , Neoplasias Pulmonares/patologia , Masculino , Pessoa de Meia-Idade , Mortalidade/tendências , Nódulos Pulmonares Múltiplos/epidemiologia , Nódulos Pulmonares Múltiplos/mortalidade , Nódulos Pulmonares Múltiplos/patologia , Administração dos Cuidados ao Paciente/estatística & dados numéricos , Administração dos Cuidados ao Paciente/tendências , Estudos Retrospectivos , Tomografia Computadorizada por Raios X/métodos
7.
Vet Radiol Ultrasound ; 60(3): 300-305, 2019 May.
Artigo em Inglês | MEDLINE | ID: mdl-30784158

RESUMO

In order to estimate the prevalence of pulmonary nodules in dogs with nonpulmonary malignant neoplasia, medical record descriptions of CT findings in dogs diagnosed with nonpulmonary malignant neoplasia were reviewed retrospectively. A total of 536 dogs were sampled from a single hospital. For malignant neoplasms with >10 affected individuals, prevalence of multiple pulmonary nodules at first CT was hemangiosarcoma 24 of 58 (41%), osteosarcoma 14 of 55 (26%), carcinoma 20 of 80 (25%), histiocytic sarcoma five of twenty-one (24%), soft tissue sarcoma 13 of 57 (23%), adenocarcinoma 11 of 60 (18%), melanoma five of thirty-seven (14%), lymphoma 10 of 76 (13%), mast cell tumor two of forty-seven (4%), and squamous cell carcinoma zero of seventeen (0%). A solitary pulmonary nodule was identified at first CT in 33 (6%) dogs. Of these, nine had follow-up CT, including two dogs in which the nodule disappeared, three dogs in which the size of the nodule did not change, and four dogs in which the nodule enlarged and additional pulmonary nodules appeared. Dogs with hemangiosarcoma were most likely to have signs of pulmonary metastasis at first CT, whereas dogs with mast cell tumor were infrequently affected, and no dog with squamous cell carcinoma had signs of pulmonary metastasis. A solitary pulmonary nodule at first CT was an indeterminate finding, potentially unassociated with neoplasia.


Assuntos
Nódulos Pulmonares Múltiplos/epidemiologia , Nódulos Pulmonares Múltiplos/veterinária , Nódulo Pulmonar Solitário/veterinária , Animais , Doenças do Cão , Cães , Feminino , Masculino , Nódulos Pulmonares Múltiplos/diagnóstico por imagem , Prevalência , Estudos Retrospectivos , Nódulo Pulmonar Solitário/diagnóstico por imagem , Nódulo Pulmonar Solitário/epidemiologia , Tomografia Computadorizada por Raios X/veterinária
8.
Thorax ; 74(3): 247-253, 2019 03.
Artigo em Inglês | MEDLINE | ID: mdl-30591535

RESUMO

BACKGROUND: The US guidelines recommend low-dose CT (LDCT) lung cancer screening for high-risk individuals. New solid nodules after baseline screening are common and have a high lung cancer probability. Currently, no evidence exists concerning the risk stratification of non-resolving new solid nodules at first LDCT screening after initial detection. METHODS: In the Dutch-Belgian Randomized Lung Cancer Screening (NELSON) trial, 7295 participants underwent the second and 6922 participants the third screening round. We included participants with solid nodules that were registered as new or <15 mm³ (study detection limit) at previous screens and received additional screening after initial detection, thereby excluding high-risk nodules according to the NELSON management protocol (nodules ≥500 mm3). RESULTS: Overall, 680 participants with 1020 low-risk and intermediate-risk new solid nodules were included. A total of 562 (55%) new solid nodules were resolving, leaving 356 (52%) participants with a non-resolving new solid nodule, of whom 25 (7%) were diagnosed with lung cancer. At first screening after initial detection, volume doubling time (VDT), volume, and VDT combined with a predefined ≥200 mm3 volume cut-off had high discrimination for lung cancer (VDT, area under the curve (AUC): 0.913; volume, AUC: 0.875; VDT and ≥200 mm3 combination, AUC: 0.939). Classifying a new solid nodule with either ≤590 days VDT or ≥200 mm3 volume positive provided 100% sensitivity, 84% specificity and 27% positive predictive value for lung cancer. CONCLUSIONS: More than half of new low-risk and intermediate-risk solid nodules in LDCT lung cancer screening resolve. At follow-up, growth assessment potentially combined with a volume limit can be used for risk stratification. TRIAL REGISTRATION NUMBER: ISRCTN63545820; pre-results.


Assuntos
Detecção Precoce de Câncer , Neoplasias Pulmonares/diagnóstico , Nódulos Pulmonares Múltiplos/diagnóstico por imagem , Nódulos Pulmonares Múltiplos/epidemiologia , Idoso , Bélgica , Estudos de Coortes , Feminino , Humanos , Incidência , Masculino , Pessoa de Meia-Idade , Países Baixos , Sensibilidade e Especificidade , Tomografia Computadorizada por Raios X
9.
Lung Cancer ; 120: 122-129, 2018 06.
Artigo em Inglês | MEDLINE | ID: mdl-29748006

RESUMO

OBJECTIVES: Pulmonary nodules have become common incidental findings with the widespread use of computed tomography (CT) technology. Such nodules have the potential to become early lung cancer lesions, so understanding more about factors that may be associated with them is important. MATERIALS AND METHODS: The present work was based on a large prospective cohort comprising 32,438 participants in Hebei Province (China) between January 2014 and March 2016. Participants aged 40-75 years completed a questionnaire, underwent low-dose CT (LDCT), and were followed up to March 2017. Grouped by the results of LDCT, normal participants and those with pulmonary nodules were included in the data analysis. RESULTS: In total 7752 subjects were included in this study, of whom 2040 (26.32%) were pulmonary nodule patients. Older age, current smoking status (hazard ratio (HR) = 1.43, 95% confidence interval (95%CI): 1.21, 1.68), exposure to second-hand smoke (SHS) at work (HR = 1.17, 95%CI: 1.01, 1.35), dust exposure (HR = 1.49, 95%CI: 1.06, 2.11), history of lung disease (HR = 1.44, 95%CI: 1.16, 1.77), and family history of cancer (HR = 1.28, 95%CI: 1.12, 1.48) were associated with pulmonary nodules. However, consumption of vegetables (HR = 0.82, 95%CI: 0.68, 0.99), tea (HR = 0.88, 95%CI: 0.78, 0.99) and legumes reduced the risk. Approximately 10.09% and 8.58% of pulmonary nodule incidences were attributed to tobacco smoking and low fruit intake, respectively. An estimated 6.36% and 3.88% of patients with pulmonary nodules attributable to family history of cancer and history of lung disease were detected. CONCLUSION: The results of this study suggest that age, smoking, SHS, dietary factors, occupational exposures, history of disease and family history of cancer may affect the incidence of pulmonary nodules.


Assuntos
Neoplasias Pulmonares/epidemiologia , Nódulos Pulmonares Múltiplos/epidemiologia , Poluição por Fumaça de Tabaco/efeitos adversos , Idoso , China/epidemiologia , Estudos de Coortes , Feminino , Humanos , Incidência , Masculino , Pessoa de Meia-Idade , Exposição Ocupacional/efeitos adversos , Modelos de Riscos Proporcionais , Estudos Prospectivos , Fatores de Risco
10.
Thorax ; 73(8): 741-747, 2018 08.
Artigo em Inglês | MEDLINE | ID: mdl-29661918

RESUMO

PURPOSE: New nodules after baseline are regularly found in low-dose CT lung cancer screening and have a high lung cancer probability. It is unknown whether morphological and location characteristics can improve new nodule risk stratification by size. METHODS: Solid non-calcified nodules detected during incidence screening rounds of the randomised controlled Dutch-Belgian lung cancer screening (NELSON) trial and registered as new or previously below detection limit (15 mm3) were included. A multivariate logistic regression analysis with lung cancer as outcome was performed, including previously established volume cut-offs (<30 mm3, 30-<200 mm3 and ≥200 mm3) and nodule characteristics (location, distribution, shape, margin and visibility <15 mm3 in retrospect). RESULTS: Overall, 1280 new nodules were included with 73 (6%) being lung cancer. Of nodules ≥30 mm3 at detection and visible <15 mm3 in retrospect, 22% (6/27) were lung cancer. Discrimination based on volume cut-offs (area under the receiver operating characteristic curve (AUC): 0.80, 95% CI 0.75 to 0.84) and continuous volume (AUC: 0.82, 95% CI 0.77 to 0.87) was similar. After adjustment for volume cut-offs, only location in the right upper lobe (OR 2.0, P=0.012), central distribution (OR 2.4, P=0.001) and visibility <15 mm3 in retrospect (OR 4.7, P=0.003) remained significant predictors for lung cancer. The Hosmer-Lemeshow test (P=0.75) and assessment of bootstrap calibration curves indicated adequate model fit. Discrimination based on the continuous model probability (AUC: 0.85, 95% CI 0.81 to 0.89) was superior to volume cut-offs alone, but when stratified into three risk groups (AUC: 0.82, 95% CI 0.78 to 0.86), discrimination was similar. CONCLUSION: Contrary to morphological nodule characteristics, growth-independent characteristics may further improve volume-based new nodule lung cancer prediction, but in a three-category stratification approach, this is limited. TRIAL REGISTRATION NUMBER: ISRCTN63545820; pre-results.


Assuntos
Neoplasias Pulmonares/diagnóstico por imagem , Nódulos Pulmonares Múltiplos/diagnóstico por imagem , Tomografia Computadorizada por Raios X/métodos , Idoso , Bélgica/epidemiologia , Diagnóstico Diferencial , Detecção Precoce de Câncer , Feminino , Humanos , Incidência , Neoplasias Pulmonares/epidemiologia , Neoplasias Pulmonares/patologia , Masculino , Programas de Rastreamento , Pessoa de Meia-Idade , Nódulos Pulmonares Múltiplos/epidemiologia , Nódulos Pulmonares Múltiplos/patologia , Países Baixos/epidemiologia , Interpretação de Imagem Radiográfica Assistida por Computador
12.
Rev Med Chil ; 146(11): 1261-1268, 2018 Nov.
Artigo em Espanhol | MEDLINE | ID: mdl-30725039

RESUMO

BACKGROUND: Pulmonary nodules are common, and surgery is the only alternative that allows a diagnostic and therapeutic management in a single procedure. AIM: To report the epidemiological, radiological, surgical and pathological features of excised pulmonary nodules. MATERIAL AND METHODS: Review of medical records of patients in whom a pulmonary nodule was excised between 2014 and 2018. Those with incomplete data or without a pathological study were excluded from analysis. RESULTS: We retrieved 108 records and 8 had to be excluded, therefore 100 patients aged 34 to 82 years (57% females) were analyzed. Sixty percent had a history of smoking. Mean nodule size was 16 mm and the solid type was the most common (65%). Forty five percent of nodules had irregular margins and 55% were in the superior lobes. All patients operated by video-assisted thoracoscopic surgery and 40% underwent a lobectomy. Malignant lesions were observed in 87% of biopsies and a pulmonary adenocarcinoma was found in pathology in 40%. CONCLUSIONS: A multidisciplinary approach of pulmonary nodules, using adapted international guidelines, accomplishes an appropriate management, decreasing unnecessary surgical interventions.


Assuntos
Adenocarcinoma de Pulmão/patologia , Carcinoma/patologia , Neoplasias Pulmonares/patologia , Nódulos Pulmonares Múltiplos/patologia , Adenocarcinoma de Pulmão/epidemiologia , Adenocarcinoma de Pulmão/cirurgia , Adulto , Idoso , Idoso de 80 Anos ou mais , Carcinoma/epidemiologia , Carcinoma/cirurgia , Chile/epidemiologia , Feminino , Humanos , Neoplasias Pulmonares/epidemiologia , Neoplasias Pulmonares/cirurgia , Masculino , Pessoa de Meia-Idade , Nódulos Pulmonares Múltiplos/epidemiologia , Nódulos Pulmonares Múltiplos/cirurgia , Estudos Retrospectivos , Distribuição por Sexo , Cirurgia Torácica Vídeoassistida/métodos , Carga Tumoral
13.
Radiology ; 286(1): 298-306, 2018 01.
Artigo em Inglês | MEDLINE | ID: mdl-28837413

RESUMO

Purpose To extract radiologic features from small pulmonary nodules (SPNs) that did not meet the original criteria for a positive screening test and identify features associated with lung cancer risk by using data and images from the National Lung Screening Trial (NLST). Materials and Methods Radiologic features in SPNs in baseline low-dose computed tomography (CT) screening studies that did not meet NLST criteria to be considered a positive screening examination were extracted. SPNs were identified for 73 incident case patients who were given a diagnosis of lung cancer at either the first or second follow-up screening study and for 157 control subjects who had undergone three consecutive negative screening studies. Multivariable logistic regression was used to assess the association between radiologic features and lung cancer risk. All statistical tests were two sided. Results Nine features were significantly different between case patients and control subjects. Backward elimination followed by bootstrap resampling identified a reduced model of highly informative radiologic features with an area under the receiver operating characteristic curve of 0.932 (95% confidence interval [CI]: 0.88, 0.96), a specificity of 92.38% (95% CI: 52.22%, 84.91%), and a sensitivity of 76.55% (95% CI: 87.50%, 95.35%) that included total emphysema score (odds ratio [OR] = 1.71; 95% CI: 1.39, 2.01), attachment to vessel (OR = 2.41; 95% CI: 0.99, 5.81), nodule location (OR = 3.25; 95% CI: 1.09, 8.55), border definition (OR = 7.56; 95% CI: 1.89, 30.8), and concavity (OR = 2.58; 95% CI: 0.89, 5.64). Conclusion A set of clinically relevant radiologic features were identified that that can be easily scored in the clinical setting and may be of use to determine lung cancer risk among participants with SPNs. © RSNA, 2017 Online supplemental material is available for this article.


Assuntos
Interpretação de Imagem Assistida por Computador/métodos , Neoplasias Pulmonares/diagnóstico por imagem , Neoplasias Pulmonares/epidemiologia , Nódulos Pulmonares Múltiplos/diagnóstico por imagem , Nódulos Pulmonares Múltiplos/epidemiologia , Tomografia Computadorizada por Raios X/métodos , Idoso , Estudos de Casos e Controles , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Análise Multivariada , Estados Unidos/epidemiologia
14.
Lung Cancer ; 114: 1-5, 2017 12.
Artigo em Inglês | MEDLINE | ID: mdl-29173759

RESUMO

OBJECTIVES: To assess whether an additional chest ultra-low-dose CT scan to the coronary CT angiography protocol can be used for lung cancer screening among patients with suspected coronary artery disease. METHODS: 175 patients underwent coronary CT angiography for assessment of coronary artery disease, additionally undergoing ultra-low-dose CT screening to early diagnosis of lung cancer in the same scanner (80kVp and 15mAs). Patients presenting pulmonary nodules were followed-up for two years, repeating low-dose CTs in intervals of 3, 6, or 12 months based on nodule size and growth rate in accordance with National Comprehensive Cancer Network guidelines. RESULTS: Ultra-low-dose CT identified 71 patients with solitary pulmonary nodules (41%), with a mean diameter of 5.50±4.00mm. Twenty-eight were >6mm, and in 79% (n=22) of these cases they were false positive findings, further confirmed by follow-up (n=20), resection (n=1), or biopsy (n=1). Lung cancer was detected in six patients due to CT screening (diagnostic yield: 3%). Among these, four cases could not be detected in the cardiac field of view. Most patients were in early stages of the disease. Two patients diagnosed at advanced stages died due to cancer complications. The addition of the ultra-low-dose CT scan represented a radiation dose increment of 1.22±0.53% (effective dose, 0.11±0.03mSv). CONCLUSIONS: Lung cancer might be detected using additional ultra-low-dose protocols in coronary CT angiography scans among patients with suspected coronary artery disease.


Assuntos
Angiografia por Tomografia Computadorizada/métodos , Doença das Coronárias/diagnóstico por imagem , Detecção Precoce de Câncer/métodos , Neoplasias Pulmonares/diagnóstico por imagem , Tórax/diagnóstico por imagem , Tomografia Computadorizada por Raios X/métodos , Idoso , Doença das Coronárias/complicações , Doença das Coronárias/patologia , Feminino , Humanos , Neoplasias Pulmonares/patologia , Masculino , Programas de Rastreamento , Pessoa de Meia-Idade , Nódulos Pulmonares Múltiplos/diagnóstico por imagem , Nódulos Pulmonares Múltiplos/epidemiologia , Prevalência , Estudos Prospectivos , Doses de Radiação , Nódulo Pulmonar Solitário/diagnóstico por imagem , Nódulo Pulmonar Solitário/epidemiologia
15.
Intern Med J ; 47(12): 1385-1392, 2017 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-28782248

RESUMO

BACKGROUND: Clinical prediction models and 18-fluorine-fluorodeoxyglucose positron emission tomography/computed tomography (18F-FDG-PET/CT) are used for the assessment of solitary pulmonary nodules (SPN); however, a biopsy is still required before treatment, which carries risk. AIM: To determine the combined predictive benefit of one such model combined with modern PET/CT data to improve decision-making about biopsy prior to treatment and possibly reduce costs. METHODS: Patients with a SPN undergoing 18F-FDG-PET/CT from January 2011 to December 2012 were retrospectively identified; 143 patients met inclusion criteria. PET/CT studies were rated (5-point visual scale), and CT characteristics were determined. Tissue was obtained by endobronchial ultrasonography with guide sheath (EBUS-GS), CT-guided biopsy and/or surgery. EBUS-transbronchial needle aspiration (TBNA) was used instead of nodule biopsy if there were PET-positive sub-centimetre lymph nodes. RESULTS: The prediction model yielded an area under the receiver operating characteristic curve (AUC-ROC) of 64% (95% confidence interval (CI) 0.55-0.75). PET/CT increased this to 75% (95% CI 0.65-0.84). The 11% improvement is statistically significant. PET/CT score was the best single predictor for malignancy. A PET score of 1-2 had a specificity of 100% (CI 0.73-1.0), whereas a score of 4-5 had a sensitivity of only 76% (CI 0.68-0.84). No significant difference in clinical prediction scores between groups was noted. PET/CT showed the greatest benefit in true negatives and in detecting small mediastinal lymph nodes to allow EBUS-TBNA with a higher diagnostic rate. Cost analysis did not support a policy of resection-without-tissue diagnosis. CONCLUSION: PET/CT improves the clinical prediction of SPN, but its greatest use is in proving benignity. High PET scores had high false positive rates and did not add to clinical prediction. PET should be incorporated early in decision-making to allow for more effective biopsy strategies.


Assuntos
Algoritmos , Fluordesoxiglucose F18 , Nódulos Pulmonares Múltiplos/diagnóstico por imagem , Tomografia Computadorizada com Tomografia por Emissão de Pósitrons/normas , Idoso , Estudos de Coortes , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Nódulos Pulmonares Múltiplos/epidemiologia , Tomografia Computadorizada com Tomografia por Emissão de Pósitrons/métodos , Estudos Retrospectivos , Medição de Risco/métodos
16.
Head Neck ; 39(11): 2241-2248, 2017 11.
Artigo em Inglês | MEDLINE | ID: mdl-28741723

RESUMO

BACKGROUND: The management of pulmonary nodules is challenging; unfortunately, little is known about the incidence and significance of pulmonary nodules in patients with head and neck cancer. METHODS: A review was conducted of 400 consecutive patients with head and neck cancer. Imaging was reviewed to identify the incidence of nodules and patient, tumor, and radiological factors associated with the risk of malignancy. RESULTS: Nodules were found in 58% of patients, with a malignant rate of 6%. Age was the only predictor of having a nodule and advanced-stage III + IV was a predictor of malignancy (P = .023; odds ratio [OR] 10.64; confidence interval 1.33-84.98). CONCLUSION: Patients presenting with head and neck cancer have a higher incidence of pulmonary nodules and a higher risk of malignancy. In contrast to the British Thoracic Society (BTS) guidelines, which use size to guide the need for serial scans, we would recommend follow-up imaging in all patients with head and neck cancer with nodules, irrespective of size.


Assuntos
Carcinoma de Células Escamosas/complicações , Neoplasias de Cabeça e Pescoço/complicações , Neoplasias de Cabeça e Pescoço/patologia , Neoplasias Pulmonares/epidemiologia , Nódulos Pulmonares Múltiplos/epidemiologia , Fatores Etários , Idoso , Carcinoma de Células Escamosas/patologia , Feminino , Humanos , Incidência , Neoplasias Pulmonares/patologia , Masculino , Pessoa de Meia-Idade , Nódulos Pulmonares Múltiplos/patologia , Estadiamento de Neoplasias , Estudos Retrospectivos , Fatores de Risco
17.
Zhongguo Fei Ai Za Zhi ; 20(5): 341-345, 2017 May 20.
Artigo em Chinês | MEDLINE | ID: mdl-28532542

RESUMO

BACKGROUND: The detection and quantification of solid components in pulmonary subsolid nodules (SSN) are of vital importance on differential diagnosis, pathological speculation and prognosis prediction. However, no objective and wide-accepted criterion has been built up to now. The purpose of this study is to explore the optimal threshold that can be used for the detection and quantification of solid components in SSNs by using threshold segmentation method on computed tomography (CT) images. METHODS: CT images of 102 SSNs were retrospectively analyzed. To establish a reference standard, the observers made judgments on whether the solid component existed in every SSN and did manual measurements of the volume of solid component with the help of software. Threshold segmentations of every nodule were then performed using different threshold settings and all of the measured volumes were assumed to be solid volumes, then solid-to-total volume ratios were calculated. The results were compared with the reference standards using the receiver operating characteristic curve and Wilcoxon test. RESULTS: The application of thresholds as -250 HU or -300 HU resulted in high diagnostic value on the detection of solid component, with area under curve values as 0.982 and 0.977, respectively; the cut-off values of solid-to-total volume ratio were 1.10% and 6.14%, respectively; the median volumes of solid components were 202.7 mm3 (598.2 mm3), 247.1 mm3(696.0 mm3), which were not significantly different from the reference standard[199.5 mm3 (743.1 mm3)](P=0.125,1, 0.061,3). CONCLUSIONS: Threshold segmentation on chest CT images is valuable to detect and quantify the solid component on SSNs, the thresholds as -250 HU and -300 HU are recommended.
.


Assuntos
Neoplasias Pulmonares/diagnóstico por imagem , Nódulos Pulmonares Múltiplos/diagnóstico por imagem , Adulto , Idoso , China , Feminino , Humanos , Neoplasias Pulmonares/epidemiologia , Masculino , Pessoa de Meia-Idade , Nódulos Pulmonares Múltiplos/epidemiologia , Curva ROC , Estudos Retrospectivos , Tomografia Computadorizada por Raios X
18.
Pan Afr Med J ; 26: 44, 2017.
Artigo em Francês | MEDLINE | ID: mdl-28451022

RESUMO

The lungs receive the entire venous drainage of the body. This explains the high incidence of pleuropulmonary metastases originating from several cancers. The goal of this is to study the clinical manifestations of pleuro-pulmonary metastases originating from extra-thoracic cancers. We conducted a retrospective study of patients with pleuro-pulmonary metastasis whose data were collected in our department between January 2006 and december 2014. 76 patient medical records were studied. The average age was 50 years (aged 21-89 years) with a male predominance in 57.8% of cases. Clinical symptoms were mainly cough (32.8% of cases), dyspnea (23.7% of cases) and hemoptysis (11.2%). Primary cancers responsible for various pleuro-pulmonary metastases found in our case series were dominated by breast cancers in 27.6% of cases, gastro-intestinal cancers in 15.8% of cases, genital cancers in 9, 2% of cases, sarcomas in 7.8% of cases, renal cancers in 5.2% of cases, bladder cancers in 5.2% of cases, prostate cancers in 3.9% cases, ENT cancers in 3.9% of cases, thyroid cancers in 3.9% of cases, skin cancers in 2.6% of cases and cancers of unknown primary origin in 14.4% of cases respectively. Several radiologic features of pleuro-pulmonary metastases have been found in our case series; they can be isolated or combined. The most common radiologic aspect was multiple pulmonary nodules in 52.6% of cases, followed by pleurisies in 34.2% of cases, diffuse micronodules in 23.6% of cases and a solitary nodule in 3.94% of cases. Secondary pleuropulmonary cancers are frequent. They come in 3rd place after lymph nodes and liver metastases and are found in 30% of autopsies of patients with neoplasia.


Assuntos
Neoplasias Pulmonares/epidemiologia , Neoplasias/patologia , Neoplasias Pleurais/epidemiologia , Adulto , Idoso , Idoso de 80 Anos ou mais , Tosse/epidemiologia , Tosse/etiologia , Dispneia/epidemiologia , Dispneia/etiologia , Feminino , Hemoptise/epidemiologia , Hemoptise/etiologia , Humanos , Neoplasias Pulmonares/patologia , Neoplasias Pulmonares/secundário , Masculino , Pessoa de Meia-Idade , Nódulos Pulmonares Múltiplos/epidemiologia , Neoplasias/epidemiologia , Neoplasias Pleurais/patologia , Neoplasias Pleurais/secundário , Estudos Retrospectivos , Adulto Jovem
19.
Eur Radiol ; 27(7): 2802-2809, 2017 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-27798753

RESUMO

OBJECTIVES: Pulmonary nodules are commonly encountered at staging CTs in patients with extrathoracic malignancies, but their significance on a per-patient basis remains uncertain. METHODS: We undertook a retrospective analysis of pulmonary nodules identified in patients with a diagnosis of breast cancer from 2010 - 2015, evaluating nodules present at a baseline CT (i.e. prevalent nodules). We reviewed 211 patients with 248 individual nodules. RESULTS: The rate of malignancy in prevalent nodules is low, approximately 13 %. Variables associated with metastasis include pleural studding, hilar lymphadenopathy and the presence of extrapulmonary metastasis, as well as number of nodules, nodule size and nodule shape. Using a combination of these factors, we have developed an evidence-based multivariate decision tree to predict which nodules are malignant in these patients, which is 91 % accurate and 100 % sensitive for metastasis. CONCLUSIONS: We propose a simplified clinical prediction algorithm to guide radiologists and oncologists in managing patients with breast cancer and incidental pulmonary nodules. KEY POINTS: • Incidental pulmonary nodules are common on computed tomography in breast cancer patients. • Nodules present at baseline have a lower malignancy risk than incident nodules. • We present an evidence-based decision algorithm predicting which nodules are likely malignant. • This algorithm can help direct patient management.


Assuntos
Algoritmos , Neoplasias da Mama/diagnóstico , Previsões , Neoplasias Pulmonares/diagnóstico , Nódulos Pulmonares Múltiplos/diagnóstico , Neoplasias Primárias Múltiplas , Tomografia Computadorizada por Raios X/métodos , Adulto , Idoso , Idoso de 80 Anos ou mais , Feminino , Seguimentos , Humanos , Pessoa de Meia-Idade , Nódulos Pulmonares Múltiplos/epidemiologia , Valor Preditivo dos Testes , Prevalência , Estudos Retrospectivos
20.
Surgeon ; 15(4): 227-230, 2017 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-27838234

RESUMO

BACKGROUND: and purpose of the study: The frequency of lung nodules in the head and neck cancer population is unknown, currently the only guidance available recommends following local policy. The aim of this study was to determine the incidence of pulmonary nodules in our head and neck cancer group and interpret the recently updated British Thoracic Society (BTS) Lung Nodule Guidelines in a head and neck cancer setting. METHODS: 100 patients were diagnosed with head and neck cancer between July 2013-March 2014, clinico-pathological, demographic and radiological data was extracted from the electronic records. Images with lung findings were re-reviewed by a single consultant radiologist for patients with lung pathology on the initial staging CT report. RESULTS: Twenty patients (20%) had discreet pulmonary findings on CT. Eleven (11%) had lung nodules, 6 (6%) had lesions suspicious for metastasis and 3 (3%) had co-incidental bronchogenic primary cancers. These patients were re-imaged between 6 and 18 months and in 1 patient the previously identified 7 mm nodule had progressed to 16 mm at 1 year. There was no set follow up imaging protocol used. CONCLUSION: The MDT in NHS Lothian has reviewed the BTS guidance and now has a local policy for the management of lung nodules in head and neck cancer patients. Lung Nodules in the head and neck cancer population are common >10%. Higher risk patients with larger nodules should be risk assessed with validated assessment tools. PET-CT has a place in the assessment of lung nodules when risk of malignancy is high.


Assuntos
Carcinoma/secundário , Neoplasias de Cabeça e Pescoço/patologia , Neoplasias Pulmonares/secundário , Nódulos Pulmonares Múltiplos/secundário , Nódulo Pulmonar Solitário/secundário , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Carcinoma/diagnóstico por imagem , Carcinoma/epidemiologia , Carcinoma/terapia , Feminino , Seguimentos , Humanos , Incidência , Neoplasias Pulmonares/diagnóstico por imagem , Neoplasias Pulmonares/epidemiologia , Neoplasias Pulmonares/terapia , Masculino , Pessoa de Meia-Idade , Nódulos Pulmonares Múltiplos/diagnóstico por imagem , Nódulos Pulmonares Múltiplos/epidemiologia , Nódulos Pulmonares Múltiplos/terapia , Guias de Prática Clínica como Assunto , Nódulo Pulmonar Solitário/diagnóstico por imagem , Nódulo Pulmonar Solitário/epidemiologia , Nódulo Pulmonar Solitário/terapia , Tomografia Computadorizada por Raios X , Adulto Jovem
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