ObjectivesTo investigate the influence of scanning parameters (tube voltages and tube currents) on image quality and corresponding radiation doses with simulated lung nodules in chest CT.MethodsThe anthropomorphic chest phantoms with 12 simulated, randomly placed nodules of different diameters and densities in the chest were scanned by different scanning parameters. The detection rate, degree of nodular deformation, image quality (with both subjective and objective evaluation) and the corresponding radiation doses were recorded and evaluated, and the correlation between nodule detection rate, degree of nodular deformation, radiation dose and image quality using different scanning parameters was analyzed.ResultsThe image quality improved with the increase of tube voltage and tube current (P<0.05). When the tube current was constant, the CT values of the vertebral decreased gradually with the increase of tube voltages (P<0.05); however, significant difference was not detected in CT values of the lung field (P>0.05). When the tube current was 100 mAs, the lung nodules with CT values of +100 HU and ?630 HU showed statistical difference when using different tube voltage (P<0.05); but there was no significant difference in nodules of ?800 HU (P=0.57). When tube voltage was 100 kV and 120 kV each, it was possible to detect all lung nodules with a detection rate of 100%. The detection rate was 33% and 66% in 3 mm diameter when the tube current was 80 kV/15 mA and 80 kV/20 mA, respectively. The nodules deformation in nodules with a CT value of ?630 HU and diameter less than 5 mm was the most prominent (P<0.05). After analyzing the relationship between image quality and radiation doses using different tube voltages, we established a system of correlation equations: 80 kV: Y=2.625X+0.038; 100 kV: Y=14.66X+0.158; 120 kV: Y=18.59X+0.093.ConclusionsThe image quality improves with the increase of tube current and tube voltage, as well as the corresponding radiation doses. By reducing the tube voltage and increasing the tube current appropriately, the radiation doses can be reduced. Follow-up CT examination of pulmonary ground glass nodules should apply the same tube voltage imaging parameters, so as to effectively reduce the measurement error of nodule density and evaluate the change of nodules more accurately.
Solitary pulmonary nodule (SPN) is defined as a rounded opacity≤3 cm in diameter surrounded by lung parenchyma. The majority of smokers who undergo thin-section CT have SPNs, most of which are smaller than 7 mm. In the past, multiple follow-up examinations over a two-year period, including CT follow-up at 3, 6, 12, 18, and 24 months, were recommended when such nodules are detected incidentally. This policy increases radiation burden for the affected population. Nodule features such as shape, edge characteristics, cavitation, and location have not yet been found to be accurate for distinguishing benign from malignant nodules. When SPN is considered to be indeterminate in the initial exam, the risk factor of the patients should be evaluated, which includes patients' age and smoking history. The 2005 Fleischner Society guideline stated that at least 99% of all nodules 4 mm or smaller are benign; when nodule is 5-9 mm in diameter, the best strategy is surveillance. The timing of these control examinations varies according to the nodule size (4-6, or 6-8 mm) and the type of patients, specifically at low or high risk of malignancy concerned. Noncalcified nodules larger than 8 mm diameter bear a substantial risk of malignancy, additional options such as contrast material-enhanced CT, positron emission tomography (PET), percutaneous needle biopsy, and thoracoscopic resection or videoassisted thoracoscopic resection should be considered.
Lung cancer, as one of the malignant tumors with the fastest increasing morbidity and mortality in the world, has a serious impact on people's health. With the continuous advancement of medical technology, more and more medical methods are applied to lung cancer screening, which has gradually increased the detection rate of early lung cancer. At present, the standard operation for the treatment of early non-small cell lung cancer (NSCLC) is still lobectomy and mediastinal lymph node dissection. There is a growing trend to use segmentectomy for the treatment of early stage lung cancer. Anatomical segmentectomy not only removes the lesions to the maximum extent, but also preserves the lung function to the greatest extent, and its advantages are also obvious. This article reviews the progress of anatomical segmentectomy in the treatment of early NSCLC.
ObjectiveBy combining biological detection and imaging evaluation, a clinical prediction model is constructed based on a large cohort to improve the accuracy of distinguishing between benign and malignant pulmonary nodules. MethodsA retrospective analysis was conducted on the clinical data of the 32 627 patients with pulmonary nodules who underwent chest CT and testing for 7 types of lung cancer-related serum autoantibodies (7-AABs) at our hospital from January 2020 to April 2024. The univariate and multivariate logistic regression models were performed to screen independent risk factors for benign and malignant pulmonary nodules, based on which a nomogram model was established. The performance of the model was evaluated using receiver operating characteristic (ROC) curves, calibration curves, and decision curve analysis (DCA). ResultsA total of 1 017 patients with pulmonary nodules were included in the study. The training set consisted of 712 patients, including 291 males and 421 females, with a mean age of (58±12) years. The validation set included 305 patients, comprising 129 males and 176 females, with a mean age of (58±13) years. Univariate ROC curve analysis indicated that the combination of CT and 7-AABs testing achieved the highest area under the curve (AUC) value (0.794), surpassing the diagnostic efficacy of CT alone (AUC=0.667) or 7-AABs alone (AUC=0.514). Multivariate logistic regression analysis showed that radiological nodule diameter, nodule nature, and CT combined with 7-AABs detection were independent predictors, which were used to construct a nomogram prediction model. The AUC values for this model were 0.826 and 0.862 in the training and validation sets, respectively, demonstrating excellent performance in DCA. ConclusionThe combination of 7-AABs with CT significantly enhances the accuracy of distinguishing between benign and malignant pulmonary nodules. The developed predictive model provides strong support for clinical decision-making and contributes to achieving precise diagnosis and treatment of pulmonary nodules.
Lung cancer is a disease with high incidence rate and high mortality rate worldwide. Its diagnosis and treatment mode is developing constantly. Among them, multi-disciplinary team (MDT) can provide more accurate diagnosis and more individualized treatment, which can not only benefit more early patients, but also prolong the survival time of late patients. However, MDT diagnosis and treatment mode is only carried out more in provincial and municipal tertiary hospitals and has not been popularized. This article intends to introduce MDT mode and its advantages, hoping that MDT mode can be popularized and applied.
ObjectiveBy applying the mutual corroboration in the diagnosis, we aimed to improve the accuracy of preoperative imaging diagnosis, select the appropriate timing of operation and guide the follow-up time for patients with pulmonary nodules.MethodsClinical data of 1 368 patients with pulmonary nodules undergoing surgical treatment in our department from July 2016 to October 2019 were summarized. There were 531 males and 837 females at age of 44 (21-67) years. The intraoperative findings, images and pathology were classified and analyzed. The imaging pathology and pathological changes of pulmonary nodules were shown as a dynamic process through mutual collaboration and interaction.ResultsOf 1 368 patients with pulmonary nodules, 376 (27.5%) were pure ground-glass nodules, 729 (53.3%) were mixed ground-glass nodules and 263 (19.2%) were solid nodules. Among the pure ground-glass nodules, adenocarcinoma in situ (AIS) accounted for the highest proportion (156 patients), followed by microinvasive adenocarcinoma (MIA, 90 patients), atypical adenomatous hyperplasia (AAH, 85 patients), and benign tumors (20 patients). Among mixed ground-glass nodules, 495 patients were invasive adenocarcinoma (IA) and 207 patients of MIA. In solid nodules, patients were characterized by pathology of either IA (213 patients) or benign tumors (50 patients), and no patient was featured by AAH, AIS or MIA.ConclusionThe mutual collaboration and interaction can improve the accuracy of preoperative diagnosis of pulmonary nodules, and it supports the choice of operation timing and the judgment of follow-up time.
ObjectiveTo explore the efficiency of Ki-67 expression and CT imaging features in predicting the degree of invasion of lung adenocarcinoma. MethodsThe clinical data of 217 patients with pulmonary nodules, who were diagnosed as suspicious lung cancer by multi-disciplinary treatment clinic of pulmonary nodules in our hospital from September 2017 to August 2021, were retrospectively analyzed. There were 84 males and 133 females, aged 52 (25-84) years. The patients were divided into two groups according to the infiltration degree, including an adenocarcinoma in situ and microinvasive adenocarcinoma group (n=145) and an invasive adenocarcinoma group (n=72). ResultsThere was no statistical difference in the age and gender between the two groups (P>0.05). The univariate analysis showed that CK-7, P63, P40 and CK56 expressions were not different between the two groups (P=0.172, 0.468, 0.827, 0.313), while Napsin A, TTF-1 and Ki-67 expressions were statistically different (P=0.002, 0.020, <0.001). The multivariate analysis showed that Ki-67 expression was statistically different between the two groups (P<0.001). Ki-67 was positively correlated with malignant features of CT images and the degree of lung adenocarcinoma invasion (P<0.05). Ki-67 and CT imaging features alone could predict the degree of lung adenocarcinoma invasion, but their sensitivity and specificity were not high. Ki-67 combined with CT imaging features could achieve a higher prediction efficiency.ConclusionCompared with Ki-67 or CT imaging features alone, the combined prediction of Ki-67 and imaging features is more effective, which is of great significance for clinicians to select the appropriate operation occasion.
With the widespread adoption of low-dose CT screening and the extensive application of high-resolution CT, the detection rate of sub-centimeter lung nodules has significantly increased. How to scientifically manage these nodules while avoiding overtreatment and diagnostic delays has become an important clinical issue. Among them, lung nodules with a consolidation tumor ratio less than 0.25, dominated by ground-glass shadows, are particularly worthy of attention. The therapeutic challenge for this group is how to achieve precise and complete resection of nodules during surgery while maximizing the preservation of the patient's lung function. The "watershed topography map" is a new technology based on big data and artificial intelligence algorithms. This method uses Dicom data from conventional dose CT scans, combined with microscopic (22-24 levels) capillary network anatomical watershed features, to generate high-precision simulated natural segmentation planes of lung sub-segments through specific textures and forms. This technology forms fluorescent watershed boundaries on the lung surface, which highly fit the actual lung anatomical structure. By analyzing the adjacent relationship between the nodule and the watershed boundary, real-time, visually accurate positioning of the nodule can be achieved. This innovative technology provides a new solution for the intraoperative positioning and resection of lung nodules. This consensus was led by four major domestic societies, jointly with expert teams in related fields, oriented to clinical practical needs, referring to domestic and foreign guidelines and consensus, and finally formed after multiple rounds of consultation, discussion, and voting. The main content covers the theoretical basis of the "watershed topography map" technology, indications, operation procedures, surgical planning details, and postoperative evaluation standards, aiming to provide scientific guidance and exploration directions for clinical peers who are currently or plan to carry out lung nodule resection using the fluorescent microscope watershed analysis method.
ObjectiveTo explore and analyze the risk factors of pleural invasion in patients with small nodular type stage ⅠA pulmonary adenocarcinoma.MethodsFrom June 2016 to December 2017, 168 patients with small nodular type stage ⅠA pulmonary adenocarcinoma underwent surgical resection in the First Affiliated Hospital of Nanjing Medical University. There were 59 males and 109 females aged 58.7±11.5 years ranging from 28 to 83 years. The clinical data were analyzed retrospectively. Single factor Chi-square test and multivariate logistic regression were used to analyze the independent risk factors of pleural invasion.ResultsAmong 168 patients, 20 (11.9%) were pathologically confirmed with pleural invasion and 148 (88.1%) with no pleural invasion. Single factor analysis revealed significant differences (P<0.05) in nodule size, nodule status, pathological type, relation of lesion to pleura (RLP), distance of lesion to pleura (DLP), epidermal growth factor receptor (EGFR) mutation between patients with and without pleural invasion in stage ⅠA pulmonary adenocarcinoma. Logistic multivariate regression analysis showed that significant differences of nodule size, nodule status, RLP, DLP and EGFR mutation existed between the two groups (P<0.05), which were independent risk factors for pleural invasion.ConclusionImageological-pathological-biological characteristics of patients with small nodular type stage ⅠA pulmonary adenocarcinoma are closely related to pleural invasion. The possibility of pleural invasion should be evaluated by combining these parameters in clinical diagnosis and treatment.
ObjectiveTo evaluate the clinical feasibility and safety of CT-guided percutaneous microwave ablation for peripheral solitary pulmonary nodules.MethodsThe imaging and clinical data of 33 patients with pulmonary nodule less than 3 cm in diameter treated by CT-guided microwave ablation treatment (PMAT) in our hospital from July 2018 to December 2019 were retrospectively analyzed. There were 21 males and 12 females aged 38-90 (67.6±13.4) years. Among them, 26 patients were confirmed with lung cancer by biopsy and 7 patients were clinically considered as partial malignant lesions. The average diameter of 33 nodules was 0.6-3.0 (1.8±0.6) cm. The 3- and 6-month follow-up CT was performed to evaluate the therapy method by comparing the diameter and enhancement degree of lesions with 1-month CT manifestation. Short-term treatment analysis including complete response (CR), partial response (PR), stable disease (SD) and progressive disease (PD) was calculated according to the WHO modified response evaluation criteria in solid tumor (mRECIST) for short-term efficacy evaluation. Eventually the result of response rate (RR) was calculated. Progression-free survival was obtained by Kaplan–Meier analysis.ResultsCT-guided percutaneous microwave ablation was successfully conducted in all patients. Three patients suffered slight pneumothorax. There were 18 (54.5%) patients who achieved CR, 9 (27.3%) patients PR, 4 (12.1%) patients SD and 2 (6.1%) patients PD. The short-term follow-up effective rate was 81.8%. Logistic analysis demonstrated that primary and metastatic pulmonary nodules had no difference in progression-free time (log-rank P=0.624).ConclusionPMAT is of high success rate for the treatment of solitary pulmonary nodules without severe complications, which can be used as an effective alternative treatment for nonsurgical candidates.