Clinicopathologic characteristics of pulmonary ground glass opacity located preoperatively using a Hook-wire guidewire

Objective:To evaluate the relationship between the clinical and imaging features of ground glass opacity(GGO)localized using a preoperative Hook-wire guidewire and postoperative pathology.Method:Preoperative Hook-wire guidewire localization was performed in 83 patients with GGO less than 2 cm,and their clinical data,imaging data,and postoperative pathology findings were retrospectively analyzed.The images were classified as pure GGO(pGGO) or mixed GGO(mGGO).The relationship between clinical and imaging features and postoperative pathology was analyzed.Result:The 83 cases were colocalized,and the success rate of the guidewire positioning was 100%.Complications included pneumothorax(19.2% [16/83]) and the incidence of minor bleeding(30.2 [25/83]).Forty-seven patients had mGGO and 36 had pGGO.Among the 47 cases of mGGO,18(38.3%) were invasive adenocarcinoma(IAC),18(38.3%) were microinvasive adenocarcinoma(MIA),8(17.0%) were adenocarcinoma in situ(AIS),2(4.3%) were atypical adenomatous hyperplasia(AAH),and 1(2.1%) was benign.Among the 36 cases of pGGO,6(16.7%) were IAC,13(36.1%) were MIA,8(22.2%) were AIS,2(5.6%) were AAH,and 7(19.4%) cases were benign lesions.A significantly higher proportion of patients with IAC had mGGO than pGGO(21.7% vs.7.2%,respectively;p=0.004).Among patients with mGGO,a higher proportion of them had a nodule diameter of ≥1 cm than those with a diameter of <1 cm(25.5% vs.12.8%,respectively;p=0.003).There was no significant difference in age,location distribution,or pathological type.Conclusion: Preoperative CT-guided Hook-wire guidewire positioning was safe with minor complications.A significantly higher proportion of patients with IAC had mGGO than pGGO.Patients with mGGO and a nodule diameter ≥1 cm require active treatment.

Prognostic value of ground glass opacity on computed tomography in pathological stage I pulmonary adenocarcinoma: A meta-analysis

BACKGROUND The clinical role of ground glass opacity(GGO)on computed tomography(CT)in stage I pulmonary adenocarcinoma patients currently remains unclear.AIM To explore the prognostic value of GGO on CT in lung adenocarcinoma patients who were pathologically diagnosed with tumor-node-metastasis stage I.METHODS A comprehensive and systematic search was conducted through the PubMed,EMBASE and Web of Science databases up to April 3,2021.The hazard ratio(HR)and corresponding 95%confidence interval(CI)were combined to assess the association between the presence of GGO and prognosis,representing overall survival and disease-free survival.Subgroup analysis based on the ratio of GGO was also conducted.STATA 12.0 software was used for statistical analysis.RESULTS A total of 12 studies involving 4467 patients were included.The pooled results indicated that the GGO predicted favorable overall survival(HR=0.44,95%CI:0.34-0.59,P<0.001)and disease-free survival(HR=0.35,95%CI:0.18-0.70,P=0.003).Subgroup analysis based on the ratio of GGO further demonstrated that the proportion of GGO was a good prognostic indicator in pathological stage I pulmonary adenocarcinoma patients,and patients with a higher ratio of GGO showed better prognosis than patients with a lower GGO ratio did.CONCLUSION This meta-analysis manifested that the presence of GGO on CT predicted favorable prognosis in tumor-node-metastasis stage I lung adenocarcinoma.Patients with a higher GGO ratio were more likely to have a better prognosis than patients with a lower GGO ratio.

Which surgery for ground glass opacity lung nodules?

Objective:Pulmonary ground glass opacity(GGO)nodules represent a significant dilemma in oncology since its diagnosis in clinical practice has increased because of growing application of low dose computed tomography and screening program.The aim of this study is to analyze the clinical and pathological features,the overall survival(OS)and disease-free interval(DFI)in surgically resected solitary ground glass nodules in order to assess the surgical treatment of choice.Methods:We retrospectively analyzed 49 patients(M/F=25/24)with a mean age of 67.7(range,40-81)years who underwent lung resection for solitary GGO nodules among 570 reviewed CT of patients who were treated for lung neoplasms between 2010 and 2016.The cohort included 22 pure GGO nodules and 27 part solid GGOs(also called mixed GGOs).Results:Median maximum diameter of GGOs,defined as the largest axial diameter of the lesion on the lung-window setting,was 17(range,5-30)mm.GGO nodules were removed by wedge resection,segmentectomy,or lobectomy in 17(35%),9(18%),and 23(47%)cases,respectively.Pathologic diagnosis was atypical adenomatous hyperplasia(AAH),adenocarcinoma in situ(AIS),minimally invasive adenocarcinoma(MIA),invasive adenocarcinoma(IA)or multifocal adenocarcinoma(MAC)in 4(8.2%),9(18.4%),11(22.4%),22(44.9%)and 3(6.1%)cases,respectively.With a median follow up of 47 months the OS and DFI of the entire cohort was 46.3 and 43 months,respectively.The histotype(P=0.008),the dimension of GGO(P=0.014)and the PET-SUV max(P=0.001)were independent prognostic factors of worse survival.Sex,age,previous lung surgery,type of surgical resection and the mediastinal lymph-node evaluation did not impact on OS and DFI.Analyzing the 22 pure GGO nodules,we found a 3-year OS and DFI of 98%and 100%respectively,significantly different from 80%and 75%respectively of part-solid GGOs(log-rank P=0.043 and P=0.011).Conclusion:Our data suggest an indolent behaviour of tumour presenting as solitary GGO nodules,especially in case of pure GGOs.In our series wedge resections guarantee the same results in terms of OS and DFI when compared to lobectomies.Sublobar resections without mediastinal lymph-nodes evaluation represent the treatment of choice for pure-GGO.More studies are needed to assess its role for part-solid GGO nodules.

Ground glass nodules with scattered or eccentric island-shaped consolidations may have poor outcomes

Background:To explore the effect of scattered or eccentric shaped types of ground glass opacity(GGO)on outcomes of patients with solid-dominant peripheral lung adenocarcinoma.Methods:We evaluated patients with solid-dominant peripheral lung adenocarcinoma,who underwent radical surgery at Zhongshan Hospital,Fudan University,between January 2013 and December 2015.Morphologically heterogeneous solid-dominant lung adenocarcinoma in imaging findings was based on the last preoperative computed tomography(CT)scans.Endpoints were recurrence-free survival(RFS)and overall survival(OS).Kaplan-Meier analysis and the log-rank test were used to estimate survival differences.Impact factors were assessed by univariable logistic regression analysis.Results:We retrospectively collected data from 200 patients,including 170 patients with central island-shaped CT imaging,18 patients with scattered shaped CT imaging,and 12 patients with eccentric shaped CT imaging.Eleven patients experienced recurrence or metastases.Kaplan-Meier survival curves showed significant survival differences between the central island-shaped type and scattered shaped or eccentric shaped type for OS(c-stage IA:5-year OS:100%vs.92.1%;HR=0.019,p=0.0025;p-stage IA:100%vs.95.2%;HR=0.146,p=0.1139)and RFS(c-stage IA:5-year RFS:100%vs.59.7%;HR=0.001,p<0.0001;p-stage IA:100%vs.64.5%;HR<0.001,p<0.0001).Univariable logistic regression analysis showed that scattered and eccentric shaped types were related to poor outcomes(p<0.012,odds ratio=18.8)。Conclusions:Relative spatial position of GGO and solid components may affect patient outcomes.Patients with scattered or eccentric shaped GGO may have a poor prognosis.

Role of Radiological Investigations of COVID-19 Patients with Pneumonia, Karachi Pakistan

The study was conducted to determine the role of radiological investigation in assessing the severity of COVID-19 pneumonia with the help of chest X-ray (CXR), high resolution computed tomography (HRCT), and ultrasound. This was a retrospective study conducted on 105 COVID-19 patients with symptoms of fever, cough, dyspnea, loss of sense of smell and taste, body ache. Diagnostic tests PCR were positive for COVID-19 included from Medicare Cardiac and General Hospital and Jinnah Medical College Hospital Korangi (JMCH) from April to November 2020. Written informed consent was taken from all participants. This study was approved by ethical review committee, Jinnah Medical & Dental College. Real time-PCR (RT-PCR) was done for the confirmation. Radiological imaging including Chest X-ray, HRCT chest, and ultrasound was done to study the severity of symptoms. Sixty-five patients had mild to moderate symptoms with oxygen saturation between 96% - 98% and 30 patients with severe pneumonia had between saturation 50% - 55%. Patients with mild symptoms were followed up by chest X-ray showing mostly normal chest X-rays but single or patches of ground glass opacities (HRCT). HRCT of 10 patients with low oxygen saturation 50% were already done showing bilateral peripheral patchy consolidation predominantly involving mid and lower lobes. 3 patients presented with patchy lung opacities and ultrasound showing similar findings with pleural effusion and ascites. Radiological imaging, specially CT-Scan was highly significant for diagnosing COVID-19 and severity of infection even in patients with negative PCR. Chest X-ray and ultrasound were also found to be a very useful tool.

A 60-Year-Male Post Corneal Transplantation with Acute Pneumonia

Pneumonia is a common complication in organ transplantation patients. Multiple respiratory pathogens such as bacteria, viruses and fungi are potentially coexisted. A 60-year-old male with left eye post corneal transplantation developed acute severe pneumonia caused by Pneumocystis jiroveci (PJP) coinfection with Nocardia spp. and Cytomegalovirus (CMV). He was hospitalized due to acute respiratory failure. Chest radiographs and chest Computed Tomography (CT) revealed extensive ground-glass opacities. PJP was diagnosed from Bronchoalveolar Lavage Fluid (BALF). The pneumonia was persistent despite of receiving intravenous cotrimoxazole. Tracheal aspirate showed faint gram-positive filamentous beaded branching organisms. Consequently Nocardia spp. was proven. Intravenous cotrimoxazole was continued and intravenous imipenem was added. After a course of dual antibiotics, pneumonia was gradually improved. A week after, he developed the worsened acute respiratory failure. The bronchoscopy was performed. The new pathogens were not detected from BALF microbiology. The BALF cytology was unremarkable. PJP was detected by Polymerase Chain Reaction (PCR) from BALF. CMV antigenemia was detected from BALF and blood. Intravenous ganciclovir was given. This report describes PJP coinfected with Nocardia spp. and CMV in post corneal transplantation patient suffering from severe pneumonia. Multiple respiratory pathogens are common among transplantation patients representing host immunosuppression and inadequate antimicorbial prophylaxis.

Clinical outcomes and lipid-laden macrophages in Electronic cigarette/Vaping product use-Associated Lung Injury(EVALI)in a South Texas population

Objective:To describe the clinical features,proportion of lipid-laden alveolar macrophages in bronchoalveolar lavage(BAL),and short-term and 6-month to 12-month outcomes of patients with Electronic cigarette/Vaping product use-Associated Lung Injury(EVALI).Methods:Retrospective review of clinical characteristics,radiographs,and BAL samples for all patients with a history of vaping who presented with acute hypoxemic respiratory failure to the University Hospital in San Antonio,Texas from 9/2019 to 6/2020 was performed.Results:We report 16 cases(15 men;median age,30 years[range 19-75])of EVALI with a history of vaping Tetrahydrocannabinol(THC),nicotine,or both.The most common presenting symptoms were tachycardia,dyspnea,cough,and fever.All patients required supplemental oxygen,including two who required noninvasive positive pressure ventilation,and five who required mechanical ventilation.All 16 patients had bilateral ground-glass opacities(GGO)with peripheral sparing on chest computerized tomography(CT).Cultures were negative,except for one patient who tested positive for rhinovirus.COVID-19 PCR was done in one individual which was negative.Cytology demonstrated lipid-laden macrophages on Oil-Red-O stain on fresh(i.e.,without fixative)BAL in the majority of patients(N=12)with a mean lipid-saturation percentage of 78%[range,44%-100%]and the mean Colombo count of 194[range,101-359].Fifteen patients were treated with systemic corticosteroids.The median length of hospital stay was 10 days.At discharge,three patients required supplemental oxygen.Eight of those who had follow-up imaging showed resolution of GGO.One patient had a relapse of symptoms and was again treated with systemic corticosteroids and mycophenolate,with resolution of symptoms.Fourteen patients who were evaluated after discharge denied vaping post-discharge(two patients were not able to be contacted and did not keep follow-up appointments).Conclusions:Successful diagnosis and management of EVALI requires a high clinical suspicion,thorough evaluation to rule out infectious etiologies,and aggressive treatment with systemic corticosteroids,along with sustained abstinence from vaping.

Lung adenocarcinoma with GGO nodules:HRCT radiological and pathological correlation

Background:Lung cancer is the most common cancer related death in the world for the both male and female as well.Adenocarcinoma is the most common pathological type which is in increasing trend.With recent advancement of screening of lung cancer with HRCT,GGO lesion has been noted frequently.GGO is a nonspecific finding that may be caused by various disorders,including inflammatory diseases,focal fibrosis,atypical adenomatous hyperplasia,bronchoalveolar carcinoma(BAC),and adenocarcinoma.This study intends to analyze the correlation between high resolutions computed tomography(HRCT)findings and the pathological findings of lung adenocarcinoma.Material and methods:Retrospective review of 16 cases of lung adenocarcinoma lesions after surgical resection.Tumors were defined as air containing type based on ratio of maximum dimension of the tumor on mediastinal window to the maximum diameter of the tumor on lung window was≤50%and as solid density if the ratio was>50%.The correlation between CT findings(homogenous/heterogeneous,airbronchogram,pleural tag,speculation,vascular involvement,pleural thickening,margin,shape)and pathological findings were investigated.Results:Of 3 air containing 2 were pre-invasive type and 1 was invasive.Among 13 solid density type all 13 were invasive type.Presence of speculation,heterogeneous appearance was found significantly associated with pathological invasion.Conclusion:Air containing type of small cells lung adenocarcinomas are preinvasive whereas solid densities are invasive.Speculation and heterogeneous are significant factor in invasive adenocarcinoma.

Radiation and Differential Diagnosis of Computed Tomography (CT) Data for Coronavirus Infection “COVID-19” with Clinical Examples

This article is presenting data from a retrospective analysis of medical records and computed tomography (CT) scans of patients’ chests with coronavirus infection “COVID-19” who applied to the diagnostic center of URFA in Osh during the first wave of the pandemic in the Kyrgyz Republic, with a description of individual clinical cases and their differential diagnosis. Chest computed tomography is one of the main methods in visual diagnosis of pneumonia in COVID-19 in hospitalized patients, which allows determining signs, symptoms for effective treatment.