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1.
Adv Exp Med Biol ; 1213: 73-94, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32030664

RESUMO

Lung cancer is the most common cancer among men and the third most common among women in the world. Many diagnostic techniques have been introduced to diagnose lung cancer. Positron emission tomography (PET)/computed tomography (CT) examination is an image diagnostic method that performs automatic detection and distinction of lung lesions. In addition, pathological examination by biopsy is performed for lesions that are suspected of being malignant, and appropriate treatment methods are applied according to the diagnosis results. Currently, lung cancer diagnosis is performed through coordination between respiratory, radiation, and pathological diagnosis experts, but there are some tasks, such as image diagnosis, that require a large amount of time and effort to complete. Therefore, we developed a decision support system using PET/CT and microscopic images at the time of image diagnosis, which leads to appropriate treatment. In this chapter, we introduce the proposed system using deep learning and radiomic techniques.


Assuntos
Sistemas de Apoio a Decisões Clínicas , Neoplasias Pulmonares/diagnóstico por imagem , Tomografia Computadorizada com Tomografia por Emissão de Pósitrons , Aprendizado Profundo , Humanos
2.
J Comput Assist Tomogr ; 44(1): 90-94, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-31939888

RESUMO

OBJECTIVE: This study aimed to determine the potential of radiomic features extracted from preoperative computed tomography to discriminate malignant from benign indeterminate small (≤10 mm) pulmonary nodules. METHODS: A total of 197 patients with 210 nodules who underwent surgical resections between January 2011 and March 2017 were analyzed. Three hundred eighty-five radiomic features were extracted from the computed tomographic images. Feature selection and data dimension reduction were performed using the Kruskal-Wallis test, Spearman correlation analysis, and principal component analysis. The random forest was used for radiomic signature building. The receiver operating characteristic curve analysis was used to evaluate the model performance. RESULTS: Fifteen principal component features were selected for modeling. The area under the curve, sensitivity, specificity, and accuracy of the prediction model were 0.877 (95% confidence interval [CI], 0.795-0.959), 81.8% (95% CI, 72.0%-90.9%), 77.4% (95% CI, 63.9%-89.3%), and 80.0% (95% CI, 72.0%-86.7%) in the validation cohort, respectively. CONCLUSIONS: Computed tomography-based radiomic features showed good discriminative power for benign and malignant indeterminate small pulmonary nodules.


Assuntos
Interpretação de Imagem Assistida por Computador/métodos , Neoplasias Pulmonares/diagnóstico por imagem , Tomografia Computadorizada por Raios X/métodos , Adolescente , Adulto , Idoso , Estudos de Viabilidade , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Análise de Componente Principal , Curva ROC , Estudos Retrospectivos , Sensibilidade e Especificidade , Adulto Jovem
3.
N Engl J Med ; 382(6): 503-513, 2020 02 06.
Artigo em Inglês | MEDLINE | ID: mdl-31995683

RESUMO

BACKGROUND: There are limited data from randomized trials regarding whether volume-based, low-dose computed tomographic (CT) screening can reduce lung-cancer mortality among male former and current smokers. METHODS: A total of 13,195 men (primary analysis) and 2594 women (subgroup analyses) between the ages of 50 and 74 were randomly assigned to undergo CT screening at T0 (baseline), year 1, year 3, and year 5.5 or no screening. We obtained data on cancer diagnosis and the date and cause of death through linkages with national registries in the Netherlands and Belgium, and a review committee confirmed lung cancer as the cause of death when possible. A minimum follow-up of 10 years until December 31, 2015, was completed for all participants. RESULTS: Among men, the average adherence to CT screening was 90.0%. On average, 9.2% of the screened participants underwent at least one additional CT scan (initially indeterminate). The overall referral rate for suspicious nodules was 2.1%. At 10 years of follow-up, the incidence of lung cancer was 5.58 cases per 1000 person-years in the screening group and 4.91 cases per 1000 person-years in the control group; lung-cancer mortality was 2.50 deaths per 1000 person-years and 3.30 deaths per 1000 person-years, respectively. The cumulative rate ratio for death from lung cancer at 10 years was 0.76 (95% confidence interval [CI], 0.61 to 0.94; P = 0.01) in the screening group as compared with the control group, similar to the values at years 8 and 9. Among women, the rate ratio was 0.67 (95% CI, 0.38 to 1.14) at 10 years of follow-up, with values of 0.41 to 0.52 in years 7 through 9. CONCLUSIONS: In this trial involving high-risk persons, lung-cancer mortality was significantly lower among those who underwent volume CT screening than among those who underwent no screening. There were low rates of follow-up procedures for results suggestive of lung cancer. (Funded by the Netherlands Organization of Health Research and Development and others; NELSON Netherlands Trial Register number, NL580.).


Assuntos
Tomografia Computadorizada de Feixe Cônico , Detecção Precoce de Câncer/métodos , Neoplasias Pulmonares/diagnóstico por imagem , Neoplasias Pulmonares/mortalidade , Idoso , Bélgica/epidemiologia , Reações Falso-Positivas , Feminino , Humanos , Incidência , Neoplasias Pulmonares/epidemiologia , Masculino , Sobremedicalização , Pessoa de Meia-Idade , Países Baixos/epidemiologia , Sistema de Registros , Fatores Sexuais , Fumar/epidemiologia
4.
Khirurgiia (Mosk) ; (1): 61-66, 2020.
Artigo em Russo | MEDLINE | ID: mdl-31994501

RESUMO

OBJECTIVE: To develop a method for analysis of lymphatic drainage pathways from the lobe of the lung affected by non-small cell lung cancer (NSCLC) using infrared fluorescence. MATERIAL AND METHODS: A study enrolled patients with NSCLC who underwent anatomic resection of the lung with systematic lymph node dissection and preliminary intraoperative peritumoral injection of indocyanine green conjugate with human albumin. Registration of fluorescence in regional lymph nodes (LN) was carried out immediately after excision of specimen using the FLUM-808 instrumental system. RESULTS: Infrared fluorescence was observed in 117 hilar and mediastinal lymph nodes from 43 patients (2.7 nodes per a patient). Comparison of localization of fluorescent LN with localization of tumor in various lobes established significant variability of lymphatic drainage pathways. CONCLUSION: The developed method of infrared fluorescent evaluation of lymphatic drainage in patients with NSCLC confirms the necessity of systematic lymph node dissection for adequate staging.


Assuntos
Carcinoma Pulmonar de Células não Pequenas/patologia , Neoplasias Pulmonares/patologia , Metástase Linfática/diagnóstico por imagem , Estadiamento de Neoplasias/métodos , Carcinoma Pulmonar de Células não Pequenas/diagnóstico por imagem , Carcinoma Pulmonar de Células não Pequenas/fisiopatologia , Carcinoma Pulmonar de Células não Pequenas/cirurgia , Corantes , Fluorescência , Humanos , Verde de Indocianina , Raios Infravermelhos , Neoplasias Pulmonares/diagnóstico por imagem , Neoplasias Pulmonares/fisiopatologia , Neoplasias Pulmonares/cirurgia , Excisão de Linfonodo , Linfonodos/diagnóstico por imagem , Linfonodos/fisiopatologia , Linfonodos/cirurgia , Metástase Linfática/fisiopatologia
5.
Medicine (Baltimore) ; 99(2): e18678, 2020 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-31914061

RESUMO

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


Assuntos
Adenocarcinoma de Pulmão/diagnóstico por imagem , Adenocarcinoma de Pulmão/patologia , Antígeno Ki-67/biossíntese , Neoplasias Pulmonares/diagnóstico por imagem , Neoplasias Pulmonares/patologia , Tomografia Computadorizada Multidetectores/métodos , Adulto , Idoso , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Nódulos Pulmonares Múltiplos/patologia , Pleura/patologia , Estudos Retrospectivos
6.
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
7.
J Photochem Photobiol B ; 202: 111669, 2020 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-31739258

RESUMO

Herein we report the synthesis and characterization of the antifouling Gadolinium oxide (Gd2O3) nanoparticles (NPs) modified with PEG with improved biocompatibility for MR imaging purposes. In this report, using the solvothermal decomposition of Gadolinium (III) in the presence of Na3cit, monitored by surface modification with PEG and L-Cys. The synthesized nanoparticles were confirmed by the TEM, DLS and UV-Visible spectroscopy. The morphological results show normal distance across of the flawless Gd2O3-PEG-Cys-NPs show 7.9 ±â€¯0.4 nm, discretely, with a thin size exchange. This infers the surface adjustment does not obviously alteration the center size of the Gd2O3-NPs when contrasted with the perfect sodium citrate-balanced out Gd2O3-NPs. The Gd2O3-PEG-L-Cys-NPs are highly stable at room temperature, water dispersible and importantly less cytotoxic at high concentration of the NPs. The T1-weighted MR phantasm readings evidentially displayed that the formed PEG coated Gd2O3-PEG and Gd2O3-PEG-Cys-NPs with and without Cys may be performed as the promising T1-weighted MR imaging. The NPs displays no signs of toxicity against the human blood, which represents the biocompatibility for the human medicine applications. The Gd2O3-PEG-Cys-NPs shows relatively, high r1 acceptable cytocompatibility, target specific cancer cells and activate the dual mode MR imaging of lung metastasis cancer model in vitro. The development of versatile zwitterion functionalized Gd2O3 may be promising as an active nanoparticle probe for improved multi-model of MR imaging agents for various cancer diseases.


Assuntos
Meios de Contraste/química , Gadolínio/química , Neoplasias Pulmonares/diagnóstico por imagem , Imagem por Ressonância Magnética , Nanopartículas/química , Polietilenoglicóis/química , Animais , Materiais Biocompatíveis/química , Materiais Biocompatíveis/farmacologia , Linhagem Celular Tumoral , Sobrevivência Celular/efeitos dos fármacos , Cisteína/química , Hemólise/efeitos dos fármacos , Humanos , Neoplasias Pulmonares/secundário , Melanoma Experimental/patologia , Camundongos , Nanopartículas/toxicidade , Células RAW 264.7 , Transplante Homólogo
9.
Br J Radiol ; 93(1105): 20190743, 2020 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-31670581

RESUMO

OBJECTIVES: Anatomic changes may occur during chemoradiation treatment for lung cancers, requiring adaptive replanning. Here we characterize these cases. METHODS: We retrospectively studied lung cancer cases that underwent resimulation and adaptive replanning during 1/2016-3/2019. We compared first and second CT-simulation regarding tumor location, timing of change, tumor volume, anatomical alteration and change in simulation technique. We also compared dosimetric parameters between the plans, recorded local control, and overall survival outcomes. RESULTS: Out of 281 patients, 58 underwent replanning (20.6%). Histology included small cell (22.4%) and non-small cell (77.6%). Stage III was in 91.4%. Mean radiation dose of 59.4 Gray (Gy) (range 50-66Gy).Tumor location was peribronchial in 53.5%. Timing of replanning was in the first, second and final third of the treatment course in 26%, 43% and 31% respectively. Changes in gross tumor volume were observed in 74%; mean gross tumor volume was 276.7cc vs 192.7 cc (first vs second simulation, p = 0.001). Anatomical changes were identified in 35.4% including pleural fluid accumulation, atelectasis or pneumothorax alteration. Change in simulation technique was performed in 25.9%, including breath-hold or continuous positive airway pressure.Changes in dosimetric parameters when the same technique was used: lung V20Gy 26% (standard deviation, SD 7.6) vs 25.3% (SD 6.6) (p = 0.36), mean lung dose 15.1 Gy (SD 3.7) vs 14.7Gy (SD 3.3) (p = 0.23), heart V40Gy 10.2% (SD13) vs 7.2% (SD 9.8) (p = 0.037). When simulation technique changed: lung V20Gy 30.8% (SD 8.2) vs 27.3% (SD 8) (p = 0.012), mean lung dose 17.3 Gy (SD 4.4) vs 15.3 Gy (SD 3.8) (p = 0.007), heart V40Gy 11.1% (SD 14.7) vs 6.5% (SD 6.7) (p = 0.014).2 year local control was 60.7% (95% confidence interval, 34.5-79.2%), and median overall survival was 19.7 months. CONCLUSION: Adaptive replanning of radiation was performed in a fifth of locally advanced lung cancer patients. In most cases tumor volume decreased, or atelectasis resolved, causing mediastinal shifts, which, if unidentified and left uncorrected, may have led to local failure and increased toxicity. The heart V40Gy was reduced significantly in all cases, but significant reduction in lung doses was evident only if simulation technique was altered. ADVANCES IN KNOWLEDGE: In locally advanced lung cancer image-guidance with cone beam CT can detect significant mediastinal shifts and gross tumor volume changes that raise the need for adaptive replanning. Image guidance-triggered adaptive replanning should be added to the armament of advanced radiation treatment planning in locally advanced lung cancer.


Assuntos
Neoplasias Pulmonares/diagnóstico por imagem , Neoplasias Pulmonares/radioterapia , Planejamento da Radioterapia Assistida por Computador/métodos , Radioterapia Guiada por Imagem/métodos , Tomografia Computadorizada por Raios X/métodos , Adulto , Idoso , Idoso de 80 Anos ou mais , Algoritmos , Quimiorradioterapia , Feminino , Humanos , Neoplasias Pulmonares/patologia , Masculino , Pessoa de Meia-Idade , Estadiamento de Neoplasias , Dosagem Radioterapêutica , Taxa de Sobrevida
10.
Ann Otol Rhinol Laryngol ; 129(1): 23-31, 2020 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-31409114

RESUMO

OBJECTIVE: National guidelines recommend lung cancer screening (LCS) using low-dose computed tomography (LDCT) for high-risk patients, including survivors of other tobacco-related cancers like head and neck cancer (HNC). This qualitative study investigated clinicians' practices and attitudes toward LCS with LDCT with patients who have survived HNC, in the context of mandated requirements for shared decision making (SDM) using decision aids. METHODS: Thematic analysis of transcribed semi-structured clinician interviews and focus group. RESULTS: Clinicians recognized LCS' utility for some HNC survivors with smoking histories. However, they identified many challenges to SDM in diverse clinic settings, including time, workflow, uncertainty about guidelines and reimbursement, decision aids, competing patient priorities, unclear evidence, potentially heightened patient receptivity and stress, and the complexity of discussions. They also identified challenges to LCS implementation. CONCLUSIONS: While clinicians feel that LDCT LCS may benefit some HNC survivors, there are barriers both to implementing LCS SDM for these patients in primary care as currently recommended and to integrating it into cancer clinics. Challenges for SDM across settings include a lack of decision aids tailored to patients with cancer histories. Given recommendations to broaden LCS eligibility criteria, more research may be required before refinement of current guidelines.


Assuntos
Atitude do Pessoal de Saúde , Sobreviventes de Câncer , Neoplasias de Cabeça e Pescoço , Neoplasias Pulmonares/diagnóstico por imagem , Médicos , Detecção Precoce de Câncer , Humanos , Oncologistas , Médicos de Atenção Primária , Padrões de Prática Médica , Pesquisa Qualitativa , Tomografia Computadorizada por Raios X
11.
J Surg Oncol ; 121(3): 480-485, 2020 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-31853990

RESUMO

BACKGROUND: Somatostatin analog functional imaging with gallium-68 (Ga-68) dotatate positron emission tomography/computed tomography (PET/CT) has demonstrated superiority in lesion detection in patients with neuroendocrine tumors (NETs). The clinical impact of this imaging modality on US surgical and medical oncology practices has not been established. METHODS: Consecutive patients with NET at our institution who received an initial Ga-68 dotatate PET/CT between July 2017 and September 2018 were included. Ga-68 dotatate PET/CT was compared with prior imaging. RESULTS: Among 101 eligible patients, 51 of 50 were female/male, site of origin was gastroenteropancreatic (75%), unknown primary (13%), lung (8%), thymus (2%), and other (2%). All NETs were histologically well/moderately differentiated. Ga-68 dotatate imaging findings altered management in 36 (35.6%) patients: documentation of progression led to the initiation of systemic therapy in 14 patients, obviated the need for biopsy in four patients, and altered surgical plans in 7 of 14 (50%) patients referred for surgery. In 11 patients, decisions regarding peptide receptor radionucleotide therapy and somatostatin analogs were altered. CONCLUSIONS: In this series, Ga-68 dotatate PET/CT altered diagnosis and management in one-third of patients and changed operative plans in half of the patients who were referred for surgical evaluation. These results support the routine use of this imaging in the care of patients with early-stage and advanced NETs.


Assuntos
Neoplasias Intestinais/diagnóstico por imagem , Neoplasias Intestinais/terapia , Tumores Neuroendócrinos/diagnóstico por imagem , Tumores Neuroendócrinos/terapia , Compostos Organometálicos , Neoplasias Pancreáticas/diagnóstico por imagem , Neoplasias Pancreáticas/terapia , Tomografia Computadorizada com Tomografia por Emissão de Pósitrons/métodos , Neoplasias Gástricas/diagnóstico por imagem , Neoplasias Gástricas/terapia , Feminino , Radioisótopos de Gálio , Humanos , Neoplasias Intestinais/patologia , Neoplasias Pulmonares/diagnóstico por imagem , Neoplasias Pulmonares/patologia , Neoplasias Pulmonares/terapia , Imagem por Ressonância Magnética , Masculino , Pessoa de Meia-Idade , Neoplasias Primárias Desconhecidas/diagnóstico por imagem , Neoplasias Primárias Desconhecidas/patologia , Neoplasias Primárias Desconhecidas/terapia , Tumores Neuroendócrinos/patologia , Neoplasias Pancreáticas/patologia , Compostos Radiofarmacêuticos , Estudos Retrospectivos , Neoplasias Gástricas/patologia , Neoplasias do Timo/diagnóstico por imagem , Neoplasias do Timo/patologia , Neoplasias do Timo/terapia
12.
Khirurgiia (Mosk) ; (12): 91-99, 2019.
Artigo em Russo | MEDLINE | ID: mdl-31825348

RESUMO

Recently, more and more attention has been paid to the utility of artificial intelligence in medicine. Radiology differs from other medical specialties with its high digitalization, so most software developers operationalize this area of medicine. The primary condition for machine learning is met because medical diagnostic images have high reproducibility. Today, the most common anatomic area for computed tomography is the thorax, particularly with the widespread lung cancer screening programs using low-dose computed tomography. In this regard, the amount of information that needs to be processed by a radiologist is snowballing. Thus, automatic image analysis will allow more studies to be interpreted. This review is aimed at highlighting the possibilities of machine learning in the chest computed tomography.


Assuntos
Diagnóstico por Computador/tendências , Detecção Precoce de Câncer , Neoplasias Pulmonares/diagnóstico por imagem , Aprendizado de Máquina/tendências , Tórax/diagnóstico por imagem , Tomografia Computadorizada por Raios X/tendências , Detecção Precoce de Câncer/instrumentação , Detecção Precoce de Câncer/métodos , Previsões , Humanos , Reprodutibilidade dos Testes
13.
Zhonghua Jie He He Hu Xi Za Zhi ; 42(12): 888-894, 2019 Dec 12.
Artigo em Chinês | MEDLINE | ID: mdl-31826531

RESUMO

Objective: To evaluate the diagnostic value of thin-slice CT navigation combined with radial endobronchial ultrasound in peripheral lung lesions. Methods: The clinical data of patients with peripheral lung lesions diagnosed by thin-slice CT navigation combined with radial endobronchial ultrasound in National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College from November 2015 to August 2018 were retrospectively analyzed. The success rate of thin-slice CT for guiding radial endobronchial ultrasound was statistically analyzed, and the diagnostic rate, sensitivity and specificity of thin-slice CT combined with radial endobronchial ultrasound were analyzed. Results: 140 consecutive patients with 145 lesions were included, 139 lesions in 136 patients were found by thin-layer CT guidance, the success rate was 95.9%; 137 lesions in 135 patients were examined by histology and/or cytology, and 106 lesions were finally diagnosed, the diagnostic rate was 77.37%; and the diagnosis sensitivity and specificity was 88.45% and 99.96%. Histological and cytological diagnostic rate, sensitivity and specificity was 72.18% versus 63.50%, 70.58% versus 66.85%, 100% versus 88.23%, respectively. Factors influencing the diagnostic rate of thin-slice CT navigation combined with radial endobronchial ultrasound include the relationship between the lesion and the target bronchus, the location of the probe and the lesion, and the size of the lesion, and the difference between the farthest generation of bronchoscopy insertion and the bronchial generation of lesions. Five patients had mild bleeding and one ultrasonic probe was damaged. Conclusion: Thin-slice CT has a higher positive rate in guiding peripheral lung lesions with radial ultrasound, and this method has a higher diagnostic value for peripheral lung lesions.


Assuntos
Endossonografia/métodos , Neoplasias Pulmonares/diagnóstico por imagem , Neoplasias Pulmonares/patologia , Tomografia Computadorizada por Raios X/métodos , Broncoscopia/métodos , China , Humanos , Pulmão/diagnóstico por imagem , Pulmão/patologia , Valor Preditivo dos Testes , Reprodutibilidade dos Testes , Estudos Retrospectivos
14.
Medicine (Baltimore) ; 98(49): e18162, 2019 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-31804329

RESUMO

RATIONALE: The prognosis of lung cancer is dismal, which has resulted in lung carcinoma being one of the leading causes of cancer-related deaths worldwide. Non-small cell lung cancer accounts for approximately 80% of all types of lung carcinoma. The skeletal system and central nervous system are the most common distal metastatic sites in patients with lung cancer, while cutaneous and soft tissues metastasis is rare. PATIENT CONCERNS: We report a case of concomitant metastasis in the nasal tip and suspected buttocks metastasis secondary to lung cancer, who complained of repeated cough and white sputum for 6 months. DIAGNOSE: Primary lung cancer was diagnosed by bronchoscopy and biopsy, lesion on nasal tip was confirmed by biopsy. Furthermore, PET-CT scan identified the untouchable buttocks lesion that could have been easily missed. INTERVENTIONS: This patient refused systemic treatments, but he chose traditional Chinese medicine at home. OUTCOMES: He died 6 months after the diagnosis. LESSONS: The possibility of metastasis of primary cancers should be considered when encountering soft-tissue neoplasm lesions, and a biopsy of the suspicious cutaneous lesions could likely aid in the histological identification of the primary cancer. PET-CT scan could be an effective supplementary tool for the diagnosis and evaluation of cancers.


Assuntos
Neoplasias Pulmonares/patologia , Neoplasias Cutâneas/secundário , Neoplasias de Tecidos Moles/secundário , Humanos , Neoplasias Pulmonares/diagnóstico por imagem , Masculino , Pessoa de Meia-Idade , Tomografia Computadorizada com Tomografia por Emissão de Pósitrons
15.
Medicine (Baltimore) ; 98(49): e18174, 2019 12.
Artigo em Inglês | MEDLINE | ID: mdl-31804333

RESUMO

RATIONALE: Neuroendocrine tumors (NETs) of the lung account for 5% of all cases of lung cancer, which itself is the leading cause of cancer-related death worldwide. In accordance to its rarity, only few cell lines of NETs exist, which even often lack key characteristics of the primary tumor, making it difficult to study underlying molecular mechanisms. PATIENT CONCERNS: The patient reported in this case is a 71-year old woman, which never smoked but suffered under dry cough. DIAGNOSES: Chest CT-scan showed a paracardiac nodule of the lingula with 2 × 1.8 cm in diameter. INTERVENTIONS: The detected paracardiac nodule of the lingula was anatomically resected using video assisted thoracic surgery. OUTCOMES: Histopathological diagnostic of the removed tissue identified the tumor as a well-differentiated typical carcinoid (TC), which represents one of the four subgroups of pulmonary NETs. Next to the successful treatment of the patient, we were able to propagate cancer stem cells (CSCs) out of the resected tumor tissue. To the best of our knowledge, we firstly isolated CSCs of a typical carcinoid, which were positive for the prominent CSC markers CD44, CD133 and nestin, confirming their stem cell properties. Additionally, CSCs, further referred as BKZ1, expressed the neuroendocrine marker synaptophysin, verifying their neuroendocrine origin. However, nuclear synaptophysin protein was also present in other stem cell populations, suggesting a role as general stem cell marker. LESSON: In line with the importance of CSCs in cancer treatment and the lack of CSC-models for neuroendocrine neoplasms, the here described BKZ1 cancer stem cell line of a typical carcinoid represents a promising new model to study pulmonary carcinoids and particular NETs.


Assuntos
Neoplasias Pulmonares/patologia , Células-Tronco Neoplásicas/patologia , Tumores Neuroendócrinos/patologia , Idoso , Biomarcadores Tumorais , Feminino , Humanos , Neoplasias Pulmonares/diagnóstico por imagem , Tumores Neuroendócrinos/diagnóstico por imagem , Tomografia Computadorizada por Raios X
16.
Medicine (Baltimore) ; 98(49): e18276, 2019 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-31804368

RESUMO

RATIONALE: Pulmonary benign metastasizing leiomyoma (PBML) is rare, usually occurs in women who underwent hysterectomy during the reproductive years, and has no obvious clinical symptoms. A full understanding of the characteristics of PBML is important for its sequential treatment and prognosis. PATIENT CONCERNS: In this report, a 36-year-old female patient with previous uterine leiomyoma who underwent 3 surgical resections of the uterus, bilateral fallopian tubes, and partial omentum was investigated. The physical examination revealed a tumor in the right lower lobe and mediastinum and a solid nodule in the right middle lobe. DIAGNOSES: Chest computed tomography (CT) confirmed a tumor in the right lower lobe and mediastinum and a solid nodule in the right middle lobe. Further positron-emission tomography computed tomography (PET-CT) with 18F-fluorodeoxyglucose (FDG) of the whole body showed mildly intense accumulation of 18F-FDG in the tumor (maximum standardized uptake value [SUV max], 2.6). A pathological examination then confirmed the presence of fibrous and vascular tissue after CT-guided percutaneous biopsy of the tumor in the right lower lobe. Additionally, surgical resection of the tumor and nodule was performed for histological analysis and immunohistochemical assays for estrogen receptor (ER) and progesterone receptor (PR). INTERVENTIONS: The patient underwent complete tumor surgical resection and nodule wedge resection. OUTCOMES: No postoperative complications occurred. No recurrence or other signs of metastasis were found during an 18-month follow-up observation period. CONCLUSION: In this case, lung and mediastinal metastasis of uterine fibroids was observed. However, depending on only a postoperative histological analysis is insufficient for the diagnosis of PBML. Histological analysis combined with an evaluation of the expression levels of ER and PR is crucial for the diagnosis and treatment of PBML.


Assuntos
Leiomioma/patologia , Neoplasias Pulmonares/secundário , Neoplasias do Mediastino/secundário , Neoplasias Uterinas/patologia , Adulto , Feminino , Humanos , Biópsia Guiada por Imagem , Leiomioma/cirurgia , Neoplasias Pulmonares/diagnóstico por imagem , Neoplasias Pulmonares/cirurgia , Neoplasias do Mediastino/diagnóstico por imagem , Neoplasias do Mediastino/cirurgia , Neoplasias Uterinas/cirurgia
18.
Medicine (Baltimore) ; 98(52): e18414, 2019 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-31876714

RESUMO

RATIONALE: Primary pulmonary inflammatory myofibroblastic tumor (IMT) with distant metastasis is extremely rare. Moreover, metastasis of pulmonary IMT to bone marrow has never been reported in previous studies. Therapeutic approaches for anaplastic lymphoma kinase (ALK)-negative pulmonary IMT with metastasis are limited. Yet there is no report on the treatment of advanced IMT cases with anti-angiogenesis drugs. PATIENT CONCERNS: We described a patient with a complaint of fatigue, with the chest computed tomography (CT) scan revealing 2 masses in bilateral lung. DIAGNOSES: The CT-guided lung biopsy examined 1 lesion in the right lung, and the post-operative pathological diagnosis of ALK-negative pulmonary IMT was recommended. However, the lung lesions were found significantly enlarged during the subsequent visit 8 months later, along with multiple metastases to the bone and abdominal cavity. A bone marrow biopsy revealed bone marrow infiltration by spindle cells. INTERVENTIONS: The patient began to take Celecoxib due to the rapid progression of IMT, however, resulting in the aggravated gastric ulcer. He stopped taking the medicine 1 month later, with no remarkable change in the lesions by CT. Apatinib was administrated instead of Celecoxib. OUTCOMES: After the 5-month treatment of Apatinib, the mass in the abdominal cavity significantly shrank and the lung lesions slightly decreased in size. With the 9-month administration of Apatinib, the lung lesions and the abdominal mass kept stable, compared with the situation in the 5-month follow-up. LESSONS: Although pulmonary IMT shows the potential of metastasis, its metastasizing to bone marrow is a highly unusual event. Apatinib is effective for pulmonary IMT, and should be taken into consideration for the treatment of inoperable pulmonary IMT patients who lack ALK rearrangement.


Assuntos
Antineoplásicos/uso terapêutico , Neoplasias Pulmonares/tratamento farmacológico , Neoplasias de Tecido Muscular/tratamento farmacológico , Piridinas/uso terapêutico , Quinase do Linfoma Anaplásico , Humanos , Neoplasias Pulmonares/diagnóstico , Neoplasias Pulmonares/diagnóstico por imagem , Neoplasias Pulmonares/patologia , Masculino , Pessoa de Meia-Idade , Miofibroblastos/patologia , Neoplasias de Tecido Muscular/diagnóstico , Neoplasias de Tecido Muscular/patologia , Tomografia Computadorizada por Raios X
19.
J Cardiothorac Surg ; 14(1): 183, 2019 Nov 04.
Artigo em Inglês | MEDLINE | ID: mdl-31684981

RESUMO

BACKGROUND: The prognosis of patients who undergo unilateral pneumonectomy and subsequently develop a contralateral pulmonary tumor can be improved by tumor resection. Thus, surgery is a treatment option if the patient's pulmonary function and performance status are satisfactory. To date, there have been only few cases reporting thoracoscopic lung resection for pulmonary tumor after contralateral pneumonectomy because of the difficulty in respiratory management during surgery. Thoracoscopic surgery requires the maintenance of the operative field to allow the lung to collapse, and in partial lung resection we need to identify tumor localization. The identification of a tumor lesion just inferior to the pleura is easy; however, the identification of a tumor lesion in the deep parts is difficult. The tumor in the deep part of the lung segments can be easily located if the tumor-affected lobe is allowed to completely collapse. Therefore, ventilation technique should be modified according to the tumor localization. CASE PRESENTATION: Here, we report three cases of thoracoscopic partial lung resections for pulmonary tumors that developed after contralateral pneumonectomy. Intermittent manual ventilation using a tracheal tube was performed in two cases with a lesion just inferior of the pleura. The tumors in both patients were resected using automatic suturing devices while arresting manual ventilation. The affected lobe was allowed to collapse using a bronchial blocker in one of the cases with a lesion in the deep part. Furthermore, she had contralateral pneumothorax with bullae on the right upper and lower lobes of the lung. The tumor in the deep part of the lung segment and ruptured bullae were easily located and resected using automatic suturing devices. The hemodynamic status of the patients was stable, and the intra- and postoperative courses were uneventful. CONCLUSIONS: Our cases demonstrate that thoracoscopic lung resection after contralateral pneumonectomy can be performed if intermittent manual ventilation is utilized when the tumor is located just inferior to the pleura and if selective double ventilation using an intrabronchial blocker is utilized when the tumor is located in the deep part.


Assuntos
Carcinoma Adenoide Cístico/cirurgia , Neoplasias Pulmonares/cirurgia , Pneumonectomia , Adulto , Idoso , Carcinoma Adenoide Cístico/diagnóstico por imagem , Carcinoma Adenoide Cístico/secundário , Feminino , Humanos , Neoplasias Pulmonares/diagnóstico por imagem , Neoplasias Pulmonares/secundário , Masculino , Metástase Neoplásica , Toracoscopia , Tomografia Computadorizada por Raios X
20.
J Cardiothorac Surg ; 14(1): 197, 2019 Nov 13.
Artigo em Inglês | MEDLINE | ID: mdl-31722726

RESUMO

OBJECTIVE: Whether segmentectomy can be used to treat radiologically determined pure solid or solid-dominant lung cancer remains controversial owing to the invasive pathologic characteristics of these tumors despite their small size. This meta-analysis compared the oncologic outcomes after lobectomy and segmentectomy regarding relapse-free survival (RFS) and overall survival (OS) in patients with radiologically determined pure solid or solid-dominant clinical stage IA non-small cell lung cancer (NSCLC). METHODS: A literature search was performed in the MEDLINE, EMBASE, and Cochrane Central databases for information from the date of database inception to March 2019. Studies were selected according to predefined eligibility criteria. The hazard ratio (HR) and associated 95% confidence interval (CI) were extracted or calculated as the outcome measure for data combining. RESULTS: Seven eligible studies published between 2014 and 2018 enrolling 1428 patients were included in the current meta-analysis. Compared with lobectomy, segmentectomy had a significant benefit on the RFS of radiologically determined pure solid or solid-dominant clinical stage IA NSCLC patients (combined HR: 1.46; 95% CI, 1.05-2.03; P = 0.024) and there were no significant differences on the OS of these patients (HR: 1.52; 95% CI, 0.95-2.43; P = 0.08). CONCLUSIONS: Segmentectomy leads to lower survival than lobectomy for clinical stage IA NSCLC patients with radiologically determined pure solid or solid-dominant tumors. Moreover, applying lobectomy to clinical stage IA NSCLC patients with radiologically determined pure solid or solid-dominant tumors (≤2 cm) could lead to an even bigger survival advantage. However, there are some limitations in the present study, and more evidence is needed to support the conclusion.


Assuntos
Carcinoma Pulmonar de Células não Pequenas/cirurgia , Neoplasias Pulmonares/cirurgia , Recidiva Local de Neoplasia , Pneumonectomia/métodos , Carcinoma Pulmonar de Células não Pequenas/diagnóstico por imagem , Carcinoma Pulmonar de Células não Pequenas/patologia , Intervalo Livre de Doença , Humanos , Neoplasias Pulmonares/diagnóstico por imagem , Neoplasias Pulmonares/patologia , Recidiva Local de Neoplasia/diagnóstico por imagem , Estadiamento de Neoplasias , Pneumonectomia/mortalidade , Taxa de Sobrevida
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