Smart Lung Tumor Prediction Using Dual Graph Convolutional Neural Network

A significant advantage of medical image processing is that it allows non-invasive exploration of internal anatomy in great detail.It is possible to create and study 3D models of anatomical structures to improve treatment outcomes,develop more effective medical devices,or arrive at a more accurate diagnosis.This paper aims to present a fused evolutionary algorithm that takes advantage of both whale optimization and bacterial foraging optimization to optimize feature extraction.The classification process was conducted with the aid of a convolu-tional neural network(CNN)with dual graphs.Evaluation of the performance of the fused model is carried out with various methods.In the initial input Com-puter Tomography(CT)image,150 images are pre-processed and segmented to identify cancerous and non-cancerous nodules.The geometrical,statistical,struc-tural,and texture features are extracted from the preprocessed segmented image using various methods such as Gray-level co-occurrence matrix(GLCM),Histo-gram-oriented gradient features(HOG),and Gray-level dependence matrix(GLDM).To select the optimal features,a novel fusion approach known as Whale-Bacterial Foraging Optimization is proposed.For the classification of lung cancer,dual graph convolutional neural networks have been employed.A com-parison of classification algorithms and optimization algorithms has been con-ducted.According to the evaluated results,the proposed fused algorithm is successful with an accuracy of 98.72%in predicting lung tumors,and it outper-forms other conventional approaches.

Early Diagnosis of Lung Tumors for Extending Patients’ Life Using Deep Neural Networks

The medical community has more concern on lung cancer analysis.Medical experts’physical segmentation of lung cancers is time-consuming and needs to be automated.The research study’s objective is to diagnose lung tumors at an early stage to extend the life of humans using deep learning techniques.Computer-Aided Diagnostic(CAD)system aids in the diagnosis and shortens the time necessary to detect the tumor detected.The application of Deep Neural Networks(DNN)has also been exhibited as an excellent and effective method in classification and segmentation tasks.This research aims to separate lung cancers from images of Magnetic Resonance Imaging(MRI)with threshold segmentation.The Honey hook process categorizes lung cancer based on characteristics retrieved using several classifiers.Considering this principle,the work presents a solution for image compression utilizing a Deep Wave Auto-Encoder(DWAE).The combination of the two approaches significantly reduces the overall size of the feature set required for any future classification process performed using DNN.The proposed DWAE-DNN image classifier is applied to a lung imaging dataset with Radial Basis Function(RBF)classifier.The study reported promising results with an accuracy of 97.34%,whereas using the Decision Tree(DT)classifier has an accuracy of 94.24%.The proposed approach(DWAE-DNN)is found to classify the images with an accuracy of 98.67%,either as malignant or normal patients.In contrast to the accuracy requirements,the work also uses the benchmark standards like specificity,sensitivity,and precision to evaluate the efficiency of the network.It is found from an investigation that the DT classifier provides the maximum performance in the DWAE-DNN depending on the network’s performance on image testing,as shown by the data acquired by the categorizers themselves.

Short-Term Test for the Induction of Lung Tumor in Mouse by Chloroprene

In a previous study by the authors,positive results from both a case-control study and a cohort study were reported.In the present study a short-term test for the induction of mouse lung tumor by chloroprene was conducted to confirm whether chloroprene monomer itself can induce tumors.Kunming albino mice weaned at 2 weeks were subjected to inhaling 0,2.9±0.3, 19.2±1.9,and 189.0±13.3 mg/m^3 chloroprene(GC purity,99.8%)4 h daily(except Sunday) for 7 months.All survivors were killed at the end of the 8th month or when moribund.No lung tumors were found before the 6th month.Thus,survivors at the 6th month were counted as effective animals.Most lung tumors observed were papilloadenomas(50/57),and a few were adenomas(7/57).The tumor incidence in the 2.9 mg/m^3 group was 8.1% in comparison to 1.3% in the control group,with the significance level at P<0.05.The higher the concentration,the higher the incidence.Examination of the multiplicity of tumor induction also demonstrated a dose-response relationship,and the number of tumors per mouse in the 189 mg/m^3 group was significant at P<0.01.1989 Academic Press,Inc.

Detection of Lung Tumor Using ASPP-Unet with Whale Optimization Algorithm

The unstructured growth of abnormal cells in the lung tissue creates tumor.The early detection of lung tumor helps the patients avoiding the death rate and gives better treatment.Various medical image modalities can help the physicians in the diagnosis of disease.Many research works have been proposed for the early detection of lung tumor.High computation time and misidentification of tumor are the prevailing issues.In order to overcome these issues,this paper has proposed a hybrid classifier of Atrous Spatial Pyramid Pooling(ASPP)-Unet architecture withWhale Optimization Algorithm(ASPP-Unet-WOA).To get a fine tuning detection of tumor in the Computed Tomography(CT)of lung image,this model needs pre-processing using Gabor filter.Secondly,feature segmentation is done using Guaranteed Convergence Particle Swarm Optimization.Thirdly,feature selection is done using Binary Grasshopper Optimization Algorithm.This proposed(ASPPUnet-WOA)is implemented in the dataset of National Cancer Institute(NCI)Lung Cancer Database Consortium.Various performance metric measures are evaluated and compared to the existing classifiers.The accuracy of Deep Convolutional Neural Network(DCNN)is 93.45%,Convolutional Neural Network(CNN)is 91.67%,UNet obtains 95.75%and ASPP-UNet-WOA obtains 98.68%.compared to the other techniques.

Development for the lung tumor model of newborn mice induced by diethylstilbestrol

Objective： To explore a economical and effective method for building lung tumor model induced by diethylstibestrol （DES）. Methods： The carcinogenic effect of neonatal mice treated by DES was studied. The newborn mice were divided into DES, Urethan （U） and U ＋ DES groups. U group was given in 500 mg/kg dose by ip at postnatal 14 day, DES group was administered by ip at the 1 d, 8 d, 15 d in the dose of 1/7, 2/7 and 4/7 LD50 of the day when they were injected respectively for DES （I）, DES （M）, DES （H） groups. Until 26 weeks, they were anatomized and checked the formation of tumors. The organ index, tumor incidence ratio and mean number of tumors were calculated. Results： Lung tumors were apparently induced in tested neonatal mice. The incidence of lung tumor of DES （L, M, H） groups were 16.7%, 22.4% and 43.1% respectively, the U ＋ DES （L, M, H） groups were 70.4%, 90.9% and 70.8% respectively, and the U group was 53.1%. The mean numbers of lung tumors of U ＋ DES （L, M） groups were higher than those of the DES （L, M） groups respectively （P 〈 0.05）. Conclusion： The higher ratio of lung tumor incidence had been induced by DES and U joined action to neonatal mice, which may be a useful and economical method to establish a lung tumor model induced by DES.

Exploring the Need and Strategy for Intraoperative Freezing to Identify Metastatic Adenocarcinoma of the Lungs

Objective: To explore the necessity and strategy of intraoperative freezing to identify primary and metastatic adenocarcinoma of the lung. Methods: This study retrospectively analyzes the impact of failing to make a definitive diagnosis of metastatic adenocarcinoma of the lung on the clinical surgical approach in four cases of intraoperative freezing. It also examines the reasons for this failure and reviews the relevant literature. Results: All 4 cases of intraoperative freezing were diagnosed as invasive adenocarcinoma, and none of them made a definitive diagnosis of metastatic adenocarcinoma. Conclusion: It is difficult to confirm the diagnosis of metastatic adenocarcinoma of the lung by intraoperative frozen section, and the combination of patient history, rapid immunohistochemistry, and histological morphology of intraoperative frozen section for its identification can guide the surgeon to adjust the surgical approach in time and provide evidence for the establishment of surgical protocols for reference.

Progress of Immunotherapy Combined with Anti-Angiogenesis Therapy in Lung Cancer

Lung cancer is the most prevalent and fatal cancer in China and even around the world, and many patients are found in the late stage of lung cancer. For the treatment of advanced lung cancer, in addition to traditional chemotherapy modalities, many emerging treatments are increasingly significant, such as immunotherapy, anti-angiogenic therapy, and targeted therapy. An increasing number of studies have now shown that anti-angiogenic therapy improves the immune microenvironment by enhancing tumor immunity through normalization of tumor vessels. Immunization combined with anti-angiogenic therapy can exert synergistic effects and improve the prognosis of patients. This article summarizes the extent of benefit, current clinical study data, and future prospects of immunotherapy combined with anti-angiogenic agents in the treatment of advanced NSCLC.

Changes of regulatory T cells and FoxP3 gene expression in the aging process and its relationship with lung tumors in humans and mice

Background Immunosuppressive regulatory T cells （Tregs） participate in tumor immune evasion and the number and suppressive function of Tregs change with the aging process, but it is not clear whether such change leads to a higher incidence of tumors in the elderly. To this end, we designed experiments to explore the changes of Tregs and the functional gene Forkhead box P3 （FoxP3） in the aging process and its relationship with lung tumors in humans and mice. Methods The percentage of CD4＋CD25＋CD127lowTregs and expression of FoxP3 mRNA were analyzed using flow cytometry （FCM） and real-time fluorescence-based quantitative polymerase chain reaction （FQ-PCR）. Markers were analyzed in the peripheral blood （PB） of 65 elderly patients （age 〉-65 years） with primary non-small cell lung cancer （NSCLC）, 20 younger patients （aged 〈55 years） with NSCLC, 30 elderly healthy individuals and 30 young healthy individuals. Furthermore, we set up the Lewis lung cancer model with C57BL/6 female mice. Thirty-six mice were divided into a young healthy group, a middle-aged healthy group, tumor group, and an elderly tumor group. The percentage an elderly healthy group, a young tumor group, a middle-aged of CD4＋CD25＋FoxP3＋ Tregs and the expression level of FoxP3 mRNA in splenocytes were determined in the six groups. Results The percentage of peripheral CD4＋CD25＋CD127low Tregs and the expression of FoxP3 mRNA were significantly increased in elderly patients with NSCLC comparing with the other groups and in elderly healthy individuals compared with young healthy individuals. Further analysis showed that the percentage of CD4＋CD25＋CD127lowTregs and the expression of FoxP3 mRNA were closely associated with tumor node metastasis （TNM） staging in elderly patients with NSCLC. In the mouse model, the percentage of CD4＋CD25＋FoxP3＋ Tregs and the expression of FoxP3 mRNA in splenocytes of the tumor groups were significantly higher than in the healthy groups, with the highest expression in the elderly tumor group. In the healthy groups, the elderly healthy mice had the highest percentage of Tregs and expression of FoxP3 mRNA. The elderly mice had larger and heavier tumors than did the young and middle aged mice. Conclusions The up-regulation of Tregs and the FoxP3 gene with aging may play an essential role in oncogenesis and development of lung tumors in an elderly population.

Evaluation of Single Field Uniform Dose (SFUD) Proton Pencil Beam Scanning (PBS) Planning Strategy for Lung Mobile Tumor Using a Digital Phantom

Purpose: To quantitatively evaluate four different Proton SFUD PBS initial planning strategies for lung mobile tumor. Methods and Materials: A virtual lung patient’s four-dimensional computed tomography (4DCT) was generated in this study. To avoid the uncertainties from target delineation and imaging artifacts, a sphere with diameter of 3 cm representing a rigid mobile target (GTV) was inserted into the right side of the lung. The target motion is set in superior-inferior (SI) direction from ?5 mm to 5 mm. Four SFUD planning strategies were used based on: 1) Maximum-In-tensity-Projection Image (MIP-CT);2) CT_average with ITV overridden to muscle density (CTavg_muscle);3) CT_average with ITV overridden to tumor density (CTavg_tumor);4) CT_average without any override density (CTavg_only). Dose distributions were recalculated on each individual phase and accumulated together to assess the “actual” treatment. To estimate the impact of proton range uncertainties, +/?3.5% CT calibration curve was applied to the 4DCT phase images. Results: Comparing initial plan to the dose accumulation: MIP-CT based GTV D98 degraded 2.42 Gy (60.10 Gy vs 57.68 Gy). Heart D1 increased 6.19 Gy (1.88 Gy vs 8.07 Gy);CTavg_tumor based GTV D98 degraded 0.34 Gy (60.07 Gy vs 59.73 Gy). Heart D1 increased 2.24 Gy (3.74 Gy vs 5.98 Gy);CTavg_muscle based initial GTV D98 degraded 0.31 Gy (60.4 Gy vs 60.19 Gy). Heart D1 increased 3.44 Gy (4.38 Gy vs 7.82 Gy);CTavg_only based Initial GTV D98 degraded 6.63 Gy (60.11 Gy vs 53.48 Gy). Heart D1 increased 0.30 Gy (2.69 Gy vs 2.96 Gy);in the presence of ±3.5% range uncertainties, CTavg_tumor based plan’s accumulated GTV D98 degraded to 57.99 Gy (+3.5%) 59.38 Gy (?3.5%), and CTavg_muscle based plan’s accumulated GTV D98 degraded to 59.37 Gy (+3.5%) 59.37 Gy (?3.5%). Conclusion: This study shows that CTavg_Tumor and CTavg_Muscle based planning strategies provide the most robust GTV coverage. However, clinicians need to be aware that the actual dose to OARs at distal end of target may increase. The study also indicates that the current SFUD PBS planning strategy might not be sufficient to compensate the CT calibration uncertainty.

Revisions to the Tumor,Node,Metastasis staging of lung cancer(8th edition):Rationale,radiologic findings and clinical implications

The Tumor, Node, Metastasis(TNM) staging system,adopted by the Union for International Cancer Control(UICC) and the American Joint Committee on Cancer(AJCC), has been recently revised, with the new 8^(th) edition of the staging manual being published in January 2017. This edition has few but important evidencebased changes to the TNM staging system used for lung cancer. Radiologists should be aware of the updated classification system to accurately provide staging information to oncologists and oncosurgeons. In this article, we discuss the rationale, illustrate the changes with relevance to Radiology, and review the clinical implications of the 8^(th) edition of the UICC/AJCC TNM staging system with regards to lung cancer.

Investigation of Combining Serum Tumor Biomarkers and Clinical Features for Elderly Lung Cancer Diagnosis and Classification

To evaluate the diagnosis model of serum tumor biomarker and several clinical features diagnose and classification for lung cancer, the solid protein chip technology (C-12) was used to detect the biomarkers of SF, CEA, CA242, NSE, CA125, CA19-9 and CA15-3 in serum and several clinical features of tumors and benign disease in elderly lung cancer patients were collected. Set up a discriminating analysis as a function diagnostic model in clinical elderly lung cancer diagnosis and sub-type discrimination. In combination of 2 obvious clinical indicators and 2 serum markers, it is possible to provide a diagnosis tool for lung cancer. With the help of mathematic model, it is promising to reduce the misjudgment risk based on the previous experience and therefore establish a reliable diagnosing function. This model is simple, cost-effective and easy to adapt in practice, and can also be used in screening of large population.

Endostatin enhances antitumor effect of tumor antigen-pulsed dendritic cell therapy in mouse xenograft model of lung carcinoma

Objective： To investigate the antitumor effect of endostatin combined with tumor antigen-pulsed dendritic cell （DC）-T cell therapy on lung cancer. Methods： Transplanted Lewis lung cancer （LLC） models of C57BL/6 mice were established by subcutaneous injection of LLC cells in left extremity axillary. Tumor antigen-pulsed DC-T cells from spleen cells and bone of mice were cultured in vitro. Tumor-bearing mice were randomly divided into three groups, including DC- T＋endostatin group, DC-T group, and phosphate-buffered saline （PBS） control group. Microvessel density （MVD） of tumor tissue in tumor-bearing mice was determined by immunohistochemistry （IHC）. The expressions of vascular endothelial growth factor （VEGF） and hypoxia-inducible factor-1α （HIF-1α） were determined by Western blotting and IHC staining. The proportions of CD8＋ T cells, mature dendritic cells （mDC）, tumor-associated macrophages [TAM （M1/M2）], and myeloid-derived suppressor cells （MDSC） in suspended cells of tumor tissue were determined by flow cytometry. The expressions of inter｜eukin （IL）-6, IL-10, IL-17, transforming growth factor-β（TGF-β） and interferon-γ （IFN-γ） in suspended cells of tumor tissue were detected by enzyme-linked immune sorbent assay （ELISA）. Results： DC-T cells combined with endostatin remarkably suppressed tumor growth. MVD of mice in DC- T＋endostatin group was significantly lower than that of the control group and DC-T monotherapy group. The expressions of VEGF, IL-6 and IL-17 in tumors were markedly decreased, but IFN-γ, and HIF-1α increased after treating with DC-T cells combined with endostatin, compared to control group and DC-T group. In the DC- T＋endostatin group, the proportions of MDSC and TAM （M2 type） were significantly decreased, mDC and TAM （Nil type） were up-regulated, and CD8＋ T cells were recruited to infiltrate tumors, in contrast to PBS control and DC-T monotherapy. DC-T cells combined with endostatin potently reduced the expressions of IL-6, IL-10, TGF-β and IL-17 in tumor tissue, and enhanced the expression of IFN-γ. Conclusions： The study indicated the synergic antitumor effects between endostatin and tumor antigen-pulsed DC-T cells, which may be a prospective therapy strategy to achieve potent antitumor effects on lung cancer.

Incorporation of circulating tumor cells and whole-body metabolic tumor volume of 18F-FDG PET/CT improves prediction of outcome inⅢB stage small-cell lung cancer

Objective: We investigated the correlation between the number of circulating tumor cells(CTCs) and wholebody metabolic tumor volume(WBMTV) measured by 18 F-fluorodeoxyglucose(FDG) positron emission tomography/computed tomography(PET/CT).The aim was to evaluate the value of the incorporation of CTC number and WBMTV in the prognostic prediction of stage III small-cell lung cancer(SCLC).Methods: One hundred and twenty-nine patients were enrolled in this study.All patients were treated with four cycles of a platinum-based regimen and concurrent chest irradiation,followed by prophylactic cranial irradiation.Blood samples for CTC analysis were obtained from 112 patients before the initiation of chemotherapy(as a baseline),after cycle 1 and after cycle 4.CTCs were measured using the CELLSEARCH? system.The patients underwent pretreatment FDG PET/CT WBMTV,which included all malignant lesions.The Spearman rank test was used to determine the correlation among CTC counts,WBMTV and disease stage.Overall survival(OS) and progression-free survival(PFS) curves were produced using the Kaplan-Meier method,and survival differences between groups were assessed by the log-rank test.Results: The number of CTCs at baseline did not correlate with WBMTV before the initiation of therapy(P=0.241).The number of CTCs at baseline and the WBMTV before the initiation of therapy were independent relevant factors for PFS and OS.The subgroup analysis(Group A: CTC count >19.5 and a WBMTV >266.5cm~3;Group B: CTC count >19.5 and a WBMTV ≤266.5cm~3; Group C: CTC count ≤19.5 and a WBMTV >266.5cm~3;Group D: CTC count ≤19.5 and a WBMTV ≤266.5cm~3) showed that the differences were statistically significant in the median PFS(Group A vs.D,P<0.001; Group B vs.D,P=0.018; Group C vs.D,P=0.029) and in the median OS(Group A vs.D,P<0.001; Group B vs.D,P=0.012).Conclusions: CTC number and WBMTV are related to progression and death in patients with SCLC.The incorporation of CTC number and WBMTV scans can provide a detailed prognostic prediction for SCLC.

Dosimetric Impact of Tumor Position and Lung Density Variations in Lung Stereotactic Body Radiotherapy

Purpose of this study was to evaluate the variation of the dose to gross tumor volume (GTV) related to tumor position and lung density for lung stereotactic body radiotherapy (SBRT) using a virtual phantom. The density of the equivalent lung surrounding the GTV (10 mm diameter) was defined as 0.10, 0.15, 0.25, 0.35, and 0.45 g/cm3. A planning target volume (PTV) was generated by adding a uniform 8 mm margin to the internal target volume (ITV). We defined that the 99% of the GTV should be covered by 100% of the prescribed dose using Monte Carlo (MC) calculation. The GTV structure was replicated from ITV to the PTV periphery at 1 mm intervals. Planned dose to the GTV was defined as the predicted dose in the replicated GTV structure. Simulated dose to the GTV was defined as the calculated dose in the replicated GTV structure taking into account the tumor position error. D99 of the planned dose to the GTV at the 8 mm shift position was 78.1%, 81.6%, 87.3%, 91.4% and 94.4% at equivalent lung densities of 0.10, 0.15, 0.25, 0.35, and 0.45 g/cm3, respectively. D99 of the simulated dose to the GTV at the 8 mm shift position was 96.9%, 95.3%, 94.2%, 95.1 % and 96.3% at equivalent lung densities of 0.10, 0.15, 0.25, 0.35, and 0.45 g/cm3, respectively. Planned dose to GTV is strongly dependent on lung density and tumor position errors, while simulated dose to GTV does not show any significant dependence.

Significance of Multimodality Therapy in Patients with a Superior Sulcus Tumor of the Lung: A Review Article

Despite the aggressive pursuit of diagnostic and treatment modalities for lung cancer, the treatment outcomes are still not satisfactory, and even patients with surgically resectable non-small cell lung cancer (NSCLC) are often at considerable risk of suffering recurrence and/or death from lung cancer. Regarding the treatment of patients with locally advanced, resectable NSCLC, several retrospective and prospective studies have shown the significance of multimodality treatments with preoperative chemoradiotherapy and surgical treatment. However, no definitive treatment strategies for locally advanced NSCLC patients have yet been established. One of the reasons for the lack of established treatment strategies for patients with locally advanced NSCLC is considered to be the heterogeneity of the population, i.e., cT4N0, cT3-4N1 and cT1a-3N2 tumors are included in stage IIIA disease, and superior sulcus tumors (SSTs) are also included in this classification. With regard to SST, two representative prospective phase II trials indicated the efficacy of surgical treatment following concurrent radiation and chemotherapy. In a study conducted by the Southwest Oncology Group, 110 patients with superior sulcus NSCLC were treated with two cycles of cisplatin and etoposide concurrently with 45 gray (Gy) of radiation, followed by surgical treatment and two additional cycles of chemotherapy postoperatively. The response rate (RR) to the preoperative chemoradiotherapy was 86%, and 83 patients (76%) were able to undergo complete resection. A pathological complete response (CR) was observed in 61 patients (56%), and the five-year survival of all patients and those undergoing complete resection was 44% and 54%, respectively. A phase II study conducted by the Japan Clinical Oncology Group examined the safety and efficacy of preoperative concurrent chemoradiotherapy using mitomycin, vinblastin and cisplatin followed by surgical treatment. Seventy-six patients with SST were enrolled in this study, and all received chemotherapy using two cycles of MVP concurrently with 45 Gy of radiation, followed by surgery. Neoadjuvant chemoradiotherapy resulted in a 61% RR, and pathological complete resection was successfully achieved in 51 patients (68%). A pathological CR was observed in 12 patients (16%), and the disease-free and overall survival rates at five years were 45% and 56%, respectively. Both studies showed the efficacy and tolerability of the multimodality treatment for SST, thus suggesting that multimodality treatment with preoperative chemoradiotherapy followed by surgery may therefore be an effective treatment for resectable SST. We herein review the results of retrospective and prospective studies while assessing the treatment outcomes of NSCLC patients with SST.

Effect of tumor suppressor in lung cancer-1 on growth inhibition of MG63 cell line

Objective： The aim of this study was to establish the osteosarcoma cell sublines which stably expressing tumor suppressor in lung cancer-1 （TSLC1） gene and evaluate its effect on growth inhibition of human osteosarcoma cell line MG63. Methods： The recombinant plasmid pCI-TSLC1 was stably transfected into MG63 cells with Lipofectamine 2000. The posi- tive clones were developed by selection by G418. Biological characteristics of one of the 6 cell lines which highly expressing TSLC1, namely, the M8T were studied. Cell growth was analyzed with MTT assay. 2 x 10^7cells suspended in 0.2 mL phosphate buffered saline （PBS） were injected into the two flanks of 5-6-week-old female BALB/C nu/nu athymic nude mice. The volumes of subcutaneous of tumor growth were evaluated and calculated by the formula V= Length x Width x Height x 0.5 once a week. Results： The MST cell subline which stably expressing TSLC1 was characterized by Western blot. The genetic stability and purity of M8T cells were stable. TSLC1 significantly suppressed the growth of M8T cells in vitro. Moreover, the tumorigenicity of MST cells was suppressed in vivo. Conclusion： The osteosarcoma cell sublines MST which stably expressing TSLC1 had been successfully established. The ability of growth and metastasis of MST was significantly suppressed both in vitro and in vivo.

Differential Diagnosis of Warthin's Tumor Complicated with Lung Adenocarcinoma by 18F- FDG PET/CT Imaging and Radioisotope Scanning with Tc-99m Pertechnetate:A Case Report and Literature Review

A seventy eight years old male patient underwent a whole body 18F- FDG PET/CT imaging to diagnose the lesion which was showed in the right lung by a chest X ray test and CT scan before. Besides the intense 18F- FDG uptake of the lesion in the right lung, a lesion in the left parotid gland also showed intense 18F- FDG uptake. To evaluate the pathology of the lesion in the left parotid gland, a parotid gland scintigraphy imaging with Tc-99m pertechnetate was done and revealed a Warthin＇s tumor. Later a fine needle aspiration（FNA） confirmed that it was a Warthin＇s tumor.

Glomus Tumors of the Lung: Diagnostic Considerations and Treatment

Glomus tumors derive from the glomus cell around arteriovenous anastomosis. These are rare tumors and when found are most common in the deep dermis of the extremities. In rarer cases still they have been reported to be found in the lung. These are most commonly incidental findings of solitary lesions of the lung with a pre-operative differential diagnosis of non-small cell carcinomas and carcinoids. Due to the rare nature of these tumors, they are rarely considered in the differential diagnosis and are also often misdiagnosed at the time of frozen section. We present three cases of glomus tumors of the lung with emphasis on the consideration of the method of diagnosis, histological findings and management.

肺腺癌患者胸水肿瘤细胞PD-L1/TTF-1表达及应用分析

目的探讨肺腺癌患者胸水肿瘤细胞程序性细胞死亡配体1(PD-L1)/甲状腺转录因子1(TTF-1)、PD-L1免疫组化染色的表达及与组织标本PD-L1表达一致性及其应用研究。方法选取2021年1月至2023年4月间首都医科大学附属北京朝阳医院收治的符合入组条件的50例肺腺癌患者为研究对象,比较同一病例组织标本中肿瘤细胞的PD-L1表达和胸水细胞蜡块中肿瘤细胞的PD-L1、PD-L1/TTF-1表达情况,评估它们之间表达的一致性。结果50例肺腺癌组织标本PD-L1的表达与患者性别、年龄、标本类型、病灶性质、标本来源和EGFR突变对比差异无统计学意义(P>0.05);胸水细胞蜡块中肿瘤细胞PD-L1/TTF-1免疫组化双染的表达与组织标本PD-L1表达的一致性较好(κ=0.846,P<0.05),明显高于PD-L1免疫组化单染(κ=0.754,P<0.05),与手术或活检切除标本一致性较好(κ=0.90,P<0.05),高于胸腔镜或穿刺小标本(κ=0.82,P<0.05),与原发病灶标本的一致性适中(κ=0.689,P<0.05),与转移病灶标本的一致性较好(κ=0.779,P<0.05)。结论胸水细胞学标本采用PD-L1/TTF-1免疫组化双染与组织标本PD-L1表达一致性较高,细胞蜡块PD-L1/TTF-1双染可在组织不易获取时作为一种有益补充,供临床制定免疫治疗方案参考。