Role of the texture features of images in the diagnosis of solitary pulmonary nodules in different sizes

Objective： To explore the role of the texture features of images in the diagnosis of solitary pulmonary nodules （SPNs） in different sizes. Materials and methods： A total of 379 patients with pathologically confirmed SPNs were enrolled in this study. They were divided into three groups based on the SPN sizes： ≤10, 11-20, and 〉20 mm. Their texture features were segmented and extracted. The differences in the image features between benign and malignant SPNs were compared. The SPNs in these three groups were determined and analyzed with the texture features of images. Results： These 379 SPNs were successfully segmented using the 2D Otsu threshold method and the self-adaptive threshold segmentation method. The texture features of these SPNs were obtained using the method of grey level co-occurrence matrix （GLCM）. Of these 379 patients, 120 had benign SPNs and 259 had malignant SPNs. The entropy, contrast, energy, homogeneity, and correlation were 3.5597±0.6470, 0.5384±0.2561, 0.1921±0.1256, 0.8281±0.0604, and 0.8748±0.0740 in the benign SPNs and 3.8007±0.6235, 0.6088±0.2961, 0.1673±0.1070, 0.7980±0.0555, and 0.8550±0.0869 in the malignant SPNs （all P〈0.05）. The sensitivity, specificity, and accuracy of the texture features of images were 83.3%, 90.0%, and 86.8%, respectively, for SPNs sized 〈10 mm, and were 86.6%, 88.2%, and 87.1%, respectively, for SPNs sized 11-20 mm and 94.7%, 91.8%, and 93.9%, respectively, for SPNs sized 〉20 mm. Conclusions： The entropy and contrast of malignant pulmonary nodules have been demonstrated to be higher in comparison to those of benign pulmonary nodules, while the energy, homogeneity correlation of malignant pulmonary nodules are lower than those of benign pulmonary nodules. The texture features of images can reflect the tissue features and have high sensitivity, specificity, and accuracy in differentiating SPNs. The sensitivity and accuracy increase for larger SPNs.

Comparison of three mathematical prediction models in patients with a solitary pulmonary nodule

Background： Effective methods for managing patients with solitary pulmonary nodules（SPNs） depend critically on the predictive probability of malignancy.Methods： Between July 2009 and June 2011, data on gender, age, cancer history, tumor familial history, smoking status, tumor location, nodule size, spiculation, calcification, the tumor border, and the final pathological diagnosis were collected retrospectively from 154 surgical patients with an SPN measuring 3-30 mm. Each final diagnosis was compared with the probability calculated by three predicted models—the Mayo, VA, and Peking University（PU） models. The accuracy of each model was assessed using area under the receiver operating characteristics（ROC） and calibration curves.Results： The area under the ROC curve of the PU model [0.800; 95% confidence interval（CI）： 0.708-0.891] was higher than that of the Mayo model（0.753; 95% CI： 0.650-0.857） or VA model（0.728; 95% CI： 0.623-0.833）; however, this finding was not statistically significant. To varying degrees, calibration curves showed that all three models overestimated malignancy.Conclusions： The three predicted models have similar accuracy for prediction of SPN malignancy, although the accuracy is not sufficient. For Chinese patients, the PU model may has greater predictive power.Background： Here, we introduced our short experience on the application of a new CUSA Excel ultrasonic aspiration system, which was provided by Integra Lifesciences corporation, in skull base meningiomas resection.Methods： Ten patients with anterior, middle skull base and sphenoid ridge meningioma were operated using the CUSA Excel ultrasonic aspiration system at the Neurosurgery Department of Shanghai Huashan Hospital from August 2014 to October 2014. There were six male and four female patients, aged from 38 to 61 years old（the mean age was 48.5 years old）. Five cases with tumor located at anterior skull base, three cases with tumor on middle skull base, and two cases with tumor on sphenoid ridge.Results： All the patents received total resection of meningiomas with the help of this new tool, and the critical brain vessels and nerves were preserved during operations. All the patients recovered well after operation.Conclusions： This new CUSA Excel ultrasonic aspiration system has the advantage of preserving vital brain arteries and cranial nerves during skull base meningioma resection, which is very important for skull base tumor operations. This key step would ensure a well prognosis for patients. We hope the neurosurgeons would benefit from this kind of technique.Background： The purposes of this study were to explore the effects of high mobility group protein box 1（HMGB1） gene on the growth, proliferation, apoptosis, invasion, and metastasis of glioma cells, with an attempt to provide potential therapeutic targets for the treatment of glioma. Methods： The expressions of HMGB1 in glioma cells（U251, U-87 MG and LN-18） and one control cell line（SVG p12） were detected by real time PCR and Western blotting, respectively. Then, the effects of HMGB1 on the biological behaviors of glioma cells were detected： the expression of HMGB1 in human glioma cell lines U251 and U-87 MG were suppressed using RNAi technique, then the influences of HMGB1 on the viability, cycle, apoptosis, and invasion abilities of U251 and U-87 MG cells were analyzed using in a Transwell invasion chamber. Also, the effects of HMGB1 on the expressions of cyclin D1, Bax, Bcl-2, and MMP 9 were detected. Results： As shown by real-time PCR and Western blotting, the expression of HMGB1 significantly increased in glioma cells（U251, U-87 MG, and LN-18） in comparison with the control cell line（SVG p12）; the vitality, proliferation and invasive capabilities of U251 and U-87 MG cells in the HMGB1 siR NA-transfected group were significantly lower than those in the blank control group and negative control（NC） siR NA group（P〈0.05） but showed no significant difference between the blank control group and NC siR NA group. The percentage of apoptotic U251 and U-87 MG cells was significantly higher in the HMGB1 siR NA-transfected group than in the blank control group and NC siR NA group（P〈0.05） but was similar between the latter two groups. The HMGB1 siR NA-transfected group had significantly lower expression levels of Cyclin D1, Bcl-2, and MMP-9 protein in U251 and U-87 MG cells and significantly higher expression of Bax protein than in the blank control group and NC siR NA group（P〈0.05）; the expression profiles of cyclin D1, Bax, Bcl-2, and MMP 9 showed no significant change in both blank control group and NC siR NA group. Conclusions： HMGB1 gene may promote the proliferation and migration of glioma cells and suppress its effects of apoptosis. Inhibition of the expression of HMGB1 gene can suppress the proliferation and migration of glioma cells and promote their apoptosis. Our observations provided a new target for intervention and treatment of glioma.

Dynamic contrast-enhanced MRI versus ^(18)F-FDG PET/CT: Which is better in differentiation between malignant and benign solitary pulmonary nodules?

Objective： To prospectively compare the discriminative capacity of dynamic contrast enhanced-magnetic resonance imaging（DCE-MRI） with that of^18F-fluorodeoxyglucose（^18F-FDG） positron emission tomography/computed tomography（PET/CT） in the differentiation of malignant and benign solitary pulmonary nodules（SPNs）.Methods： Forty-nine patients with SPNs were included in this prospective study. Thirty-two of the patients had malignant SPNs, while the other 17 had benign SPNs. All these patients underwent DCE-MRI and ^18F-FDG PET/CT examinations. The quantitative MRI pharmacokinetic parameters, including the trans-endothelial transfer constant（K^trans）, redistribution rate constant（Kep）, and fractional volume（Ve）, were calculated using the Extended-Tofts Linear two-compartment model. The ^18F-FDG PET/CT parameter, maximum standardized uptake value（SUV（max））, was also measured. Spearman＇s correlations were calculated between the MRI pharmacokinetic parameters and the SUV（max） of each SPN. These parameters were statistically compared between the malignant and benign nodules. Receiver operating characteristic（ROC） analyses were used to compare the diagnostic capability between the DCE-MRI and ^18F-FDG PET/CT indexes.Results： Positive correlations were found between K^trans and SUV（max）, and between K（ep） and SUV（max）（P〈0.05）.There were significant differences between the malignant and benign nodules in terms of the K^trans, K（ep） and SUV（max） values（P〈0.05）. The areas under the ROC curve（AUC） of K^trans） K（ep） and SUV（max） between the malignant and benign nodules were 0.909, 0.838 and 0.759, respectively. The sensitivity and specificity in differentiating malignant from benign SPNs were 90.6% and 82.4% for K^trans; 87.5% and 76.5% for K（ep）; and 75.0% and 70.6%for SUV（max）, respectively. The sensitivity and specificity of K^trans and K（ep） were higher than those of SUV（max）, but there was no significant difference between them（P〉0.05）.Conclusions： DCE-MRI can be used to differentiate between benign and malignant SPNs and has the advantage of being radiation free.

Decision-tree analysis for cost-effective management of solitary pulmonary nodules in China

AIM: To analyze the cost-effectiveness of the diagnosis of solitary pulmonary nodule(SPN) in China. METHODS: Decision analysis models were constructed to assess the cost-effectiveness of four strategies for the management of SPN: computed tomography(CT) alone, CT plus CT-guided automated cutting needle biopsy(ACNB), CT plus positron emission tomography/computed tomography(PET/CT), CT plus diffusionweighted magnetic resonance imaging(DWI) plus PET/CT. RESULTS: The prevalence of lung cancer among SPN discovered in the clinical setting was approximately 50%. The CT plus ACNB strategy had higher diagnostic accuracies(87% vs 81%), with a cost saving of $1945 RMB per patient, and reducing unnecessary thoracotomy by 16.5%; this was associated with a 4.5% missed diagnosis rate. CT plus DWI plus PET/CT strategy also had higher accuracies(95% vs 81%), with a cost saving of $590 RMB per patient, and reducing unneces-sary thoracotomy by 13.5%; this was accompanied by 0.3% missed diagnosis rate. CT plus PET strategy is cost effective at a prevalence rate of 0-34%, but there was a larger prevalence range of lung cancer for CT plus ACNB strategy(from 0 to 0.6) and CT plus DWI plus PET/CT strategy(from 0 to 0.64). CONCLUSION: CT plus DWI plus PET/CT strategy was cost-effective, and had a higher accuracy accompanied by a lower missed diagnosis rate than CT plus ACNB strategy.

Bronchoscopic Diagnosis of Solitary Pulmonary Nodules with the Use of NIR Spectroscopy

Background: Recently, SPN has become a much more frequently encountered issue in bronchology. Efficient and reliable guidance method for SPN morphological proof is highly needed. Objectives: The aim of study was to compare the diagnostic values of NIR (near infrared) spectroscopy with EBUS for SPN diagnostic. Fluoroscopic guidance with TBB and needle biopsy were done in all patients. Methods: In our study, we used two types of monitoring systems. Fluoroscopic guidance was combined with either a radial EBUS or a NIR spectroscopy probe for tissue confirmation. 139 male and 71 female patients, having a medial age of 68 years with CT/PET findings of metabolically active SPN were examined between 2/2010 and 2/2013. We designed an instrument for measurement of the penetration of the NIR through lung tissue. Indicating and source fibers were navigated towards the SPN. An EBUS radial probe was used, during fluoroscopic navigation. Results: The statistical analysis of the results obtained showed a comparative specificity and sensitivity of the NIR spectroscopy, with radial EBUS. Conclusions: NIR spectroscopy produced similar efficacies as the radial EBUS. However, the number of positive biopsies was more dependent upon the ability to direct the confirmatory device to the SPN during fluoroscopic guidance than on the type of the device.

Enhanced characterization of solid solitary pulmonary nodules with Bayesian analysis-based computer-aided diagnosis

The aim of this study was to prospectively assess the accuracy gain of Bayesian analysis-based computeraided diagnosis(CAD) vs human judgment alone in characterizing solitary pulmonary nodules(SPNs) at computed tomography(CT). The study included 100 randomly selected SPNs with a definitive diagnosis. Nodule features at first and follow-up CT scans as well as clinical data were evaluated individually on a 1 to 5 points risk chart by 7 radiologists, firstly blinded then aware of Bayesian Inference Malignancy Calculator(BIMC) model predictions. Raters' predictions were evaluated by means of receiver operating characteristic(ROC) curve analysis and decision analysis. Overall ROC area under the curve was 0.758 before and 0.803 after the disclosure of CAD predictions(P = 0.003). A net gain in diagnostic accuracy was found in 6 out of 7 readers. Mean risk class of benign nodules dropped from 2.48 to 2.29, while mean risk class of malignancies rose from 3.66 to 3.92. Awareness of CAD predictions also determined a significant drop on mean indeterminate SPNs(15 vs 23.86 SPNs) and raised the mean number of correct and confident diagnoses(mean 39.57 vs 25.71 SPNs). This study provides evidence supporting the integration of the Bayesian analysis-based BIMC model in SPN characterization.

Comparison of Various Parameters of DWI in Distinguishing Solitary Pulmonary Nodules

In order to prospectively assess various parameters of diffusion weighted imaging (DWI)in differential diagnosis of benign and malignant solitary pulmonary nodules (SPNs),58 patients (40 men and 18 women,and mean age of 48.1±10.4years old) with SPNs undergoing conventional MR,DWI using b=500s/mm^2 on a 1.5T MR scanner, were studied.Various DWI parameters [apparent diffusion coefficient (ADC),lesion-to-spinal cord signal intensity ratio (LSR),signal intensity (SI)score] were calculated and compared between malignant and benign SPNs groups.A receiver operating characteristic (ROC)curve analysis was employed to compare the diagnostic capabilities of all the parameters for discrimination between benign and malignant SPNs.The results showed that there were 42 malignant and 16 benign SPNs.The ADC was significantly,lower in malignant SPNs (1.40±0.44)×10^-3mm^2/s than in benign SPNs (1.81±0.58)×10^-3mm^2/ s.The LSR and SI scores were significantly increased in malignant SPNs (0.90±0.37 and 2.8±1.2)as compared with those in benign SPNs (0.68±0.39 and 2.2±1.2).The area under the ROC curves (AUC)of all parameters was not significantly different between malignant SPNs and benign SPNs.It was suggested that as three reported parameters for DWI,ADC,LSR and SI scores are all feasible for discrimination of malignant and benign SPNs.The three parameters have equal diagnostic performance.

Differentiation of Benign and Malignant Solitary Pulmonary Nodule: Literature Review

The solitary pulmonary nodule (SPN) is frequently seen on chest radiographs and computed tomography (CT), usually the identification is accidental. The overall prevalence of malignancy is relatively low but identification of malignancy of nodule is of prime importance. There are different characters of nodules indicating malignancy, and also the exposure of person to risk factors increases the chances of malignancy of nodule. Chances of malignancy rise with increasing size, the irregular, lobulated border of the nodules is highly associated with higher probability of malignancy and nodules with pure ground grass appearance have higher probability of malignancy, irregularly marginated nodule displaying a corona radiata sign indicating neoplastic infiltration with distortion of neighbouring tissue is almost certainly a malignant nodule. Stippled, punctuate, and eccentric calcifications are suggestive of malignancy. There are 20% - 75% of chances of malignancy if nodule is appeared with ground-glass opacity. Malignant nodules have higher growth rate as compared with benign nodules, malignant nodules usually have doubling time (DT) of 30 - 400 days while DT of more than 450 days is sign of benignity whereas doubling time less than 30 days is usually acute infectious process. The presence of fat within nodule is sign of benignity. Increasing density of the nodule is suggestive of malignancy and requires shorter follow up. Besides the nodule evaluation the chances of malignancy can also be evaluated through the exposure of patient to risk factors like age, current and past smoking status and history of extra thoracic malignancy. The management depends upon various factors mainly three strategies are applied for management including careful observation of nodule, use of diagnostic techniques like CT FNA, PET, and broncoscopy and surgery.

Dynamic enhanced multi-slice spiral CT in evaluation of blood flow patterns of solitary pulmonary nodules with enhancement

Objective To investigate the methods of dynamic enhanced multi-slice spiral CT in evaluation of blood flow patterns of solitary pulmonary nodules (SPNs) with enhancement. Methods Seventy-eight patients with SPNs (≤4 cm) with strong enhancement underwent dynamic multi-slice spiral CT (Marconi Mx8000) scan before and after contrast enhancement by injecting contrast material with a rate of 4 mL/s. For the 40 patients in protocol one, one scan was obtained every 2 seconds during 15--45 and 75--105 seconds after injection, while for the 38 patients in protocol two, one scan was obtained every 2 seconds during 11--41 and 71--101 seconds. For all the patients, one scan was obtained every 30 seconds during 2--9 minutes. The section thickness was 2.5 mm for lesions ≤3 cm and 5 mm for lesions >3 cm. Standard algorithm was used in the image reconstruction. Precontrast and postcontrast attenuation on every scan was recorded. The perfusion, peak height, ratio of peak height of the SPN to that of the aorta and mean transit time were calculated. Results The peak height, perfusion, ratio of peak height of the SPN to that of the aorta and mean transit time in malignant SPNs were 34.85 Hu±10.87 Hu, 30.37 ml/(min·100 g)±11.14 ml/(min·100 g), 13.78%± 3.96% , 14.19 s±6.19 s respectively in protocol one, while those in protocol two were 36.62 Hu±10.75 Hu, 30.01 ml/(min·100 g)±8.10 ml/(min·100 g), 14.70 %±4.71%, 13.91 s±4.82 s respectively. No statistically significant differences were found between the peak height (t= 0.673, P=0.503), perfusion (t= 0.152 , P=0.880), ratio of peak height of the SPN to that of the aorta (t= 0.861, P=0.393) and mean transit time (t= 0.199, P=0.843) in malignant SPNs measured in protocol one and those measured in protocol two. All mean transit time in protocol two (36/36) were obtained, but only part of them (25/32) were obtained in protocol one. Conclusion Dynamic enhanced multi-slice spiral CT is a non-invasive method for quantitative evaluation of blood flow patterns of SPNs with enhancement and scans beginning at 11 seconds after injection of contrast material is suggested.

Correlation between the quantifiable parameters of blood flow pattern derived with dynamic CT in malignant solitary pulmonary nodules and tumor size

Objective: To evaluate the correlation between the quantifiable parameters of blood flow pattern derived with dy- namic CT in malignant solitary pulmonary nodules and tumor size. Methods: Sixty-eight patients with malignant solitary pulmo- nary nodules (SPNs) (diameter ≤4 cm) underwent multi-location dynamic contrast material-enhanced (nonionic contrast material was administrated via the antecubital vein at a rate of 4mL/s by using an autoinjector, 4×5 mm or 4×2.5 mm scanning mode with stable table were performed). Precontrast and postcontrast attenuation on every scan was recorded. Blood flow (BF), peak, height (PHSPN), ratio of peak height of the SPN to that of the aorta (SPN-to-A ratio) and mean transit time (MTT) were calculat- ed. The correlation between the quantifiable parameters of blood flow pattern derived with dynamic CT in malignant solitary pul- monary nodules and tumor size were assessed by means of linear regression analysis. Results: No significant correlations were found between the tumor size and each of the peak height (PHSPN) (35.79±10.76 Hu), ratio of peak height of the SPN to that of the aorta (SPN-to-A ratio), (14.27%±4.37) and blood flow (BF) (30.18 mL/min/100 g±9.58) (r=0.180, P=0.142>0.05; r=0.205, P=0.093>0.05; r=0.008, P=0.947>0.05). Conclusion: No significant correlations were found between the tumor size and each of the quantifiable parameters of blood flow pattern derived with dynamic CT in malignant solitary pulmonary nodules.

BLOOD FLOW PATTERN AND QUANTITATIVE STUDY IN SOLITARY PULMONARY NODULES WITH DYNAMIC CONTRAST-ENHANCED MRI

Objective To evaluate the efficacy of contrast enhanced dynamic MRI in differentiating solitary pulmonary nodules(SPNs). Methods Eighty-three patients with SPNs undertaken contrast enhanced dynamic MRI. Time-signal intensity curve (T-SI Curve) was made.Peak height (PH), steepest slope (SS), maximum enhancement (E_ max ) and the enhancement rates of signal intensity were recorded at the first (E1), second (E2), third (E3), fourth (E4), fifth (E5), and sixth (E6) minute after injection. Results Malignant nodules and inflammatory nodules enhanced significantly higher than benign nodules, and malignant nodules and inflammatory nodules showed obviously higher PH, SS, Emax,E1-E6 values than benign nodules(P<0.01).There were no significant differences in PH, SS, E_ max ,E1-E6 values between malignant nodules and inflammatory nodules(P>0.05). Conclusion Contrast enhanced dynamic MR imaging can provide SPNs’ hemodynamic information and is helpful in differentiating SPNs.

The effect of single-operation-hole thoracoscopic surgery on elderly solitary pulmonary nodules and its effects on lung function and prognosis

Objective:To investigate the effect of single-operation-hole thoracoscopic surgery on elderly solitary pulmonary nodules and its effects on lung function and prognosis.Methods:64 patients with solitary pulmonary nodules admitted to our hospital were selected. According to the different surgical treatment methods, they were divided into the study group and the control group, each group with 32 cases. The study group was treated with single-operation-hole thoracoscopic pulmonary nodule resection, and the control group was treated with conventional multi-operation-holes thoracoscopic pulmonary nodule resection. The clinical efficacy of the two groups was compared. Results: The postoperative drainage time, intraoperative blood loss, hospitalization time, postoperative drainage volume and hospitalization cost of the study group were significantly better than those of the control group (P<0.05), and there were no significant differences between the two groups in terms of the duration of operation and the incidence of adverse reactions (such as postoperative pulmonary atelectasis and pulmonary infection) (P>0.05). There was no difference in lung function between the two groups before operation (P>0.05). Compared with the control group, the lung function indexes of the postoperative study group were significantly improved (P<0.05). There was no difference in the overall survival rate and tumor-free survival rate of the two groups after operation for half a year (P>0.05). The VAS scores of the study group were significantly lower than those of the control group on the 1st and 3rd day after operation (P<0.05). There was no difference in the quality of life between the two groups before treatment (P>0.05), but the overall health status, physiological feature, physiological function, physical pain and energy of the patients in the study group after treatment were significantly higher than those in the control group (P<0.05), but there was no significant difference in social function, emotional function and mental health (P>0.05).Conclusions: Single-operation-hole thoracoscopic surgery is effective in the treatment of elderly solitary pulmonary nodules. It can not only accelerate the recovery of patients but also improve their lung function, without affecting the prognosis of patients, which can improve their quality of life. It is worthy of clinical application, but should strictly control the indications for surgery.

INCREMENTAL DYNAMIC COMPUTER TOMOGRAPHY IN SURGICAL TREATMENT OF PATIENTS WITH SOLITARY PULMONARY NODULES

Objective The purpose of this study is to appraise the value of incremental dynamic enhanced computed tomography in surgical treatment of patients with solitary pulmonary nodules(SPNs).Methods The data of 42 cases with solitary pulmonary nodules who underwent surgical treatment from May 2002 to June 2003 in our hospital were collected to find the relationship between preoperative dynamic enhanced CT image and postoperative pathology.Result All bronchogenic carcinoma showed significant enhancement after intravenous 100 mL iodinated contrast material.The average degree of enhancement of bronchogenic carcinoma was significantly different from that of tuberculoma and other benign lesions.Conclusion Dynamic enhanced computed tomography is very valuable in distinguishing between malignant nodules and benign ones.Emphasis should be paid to lymph nodes in the dynamic enhanced computed tomography,which is useful both to the diagnosis of SPN and for surgical treatment.

Advancements in Medication Rule for Pulmonary Nodules: A Review of Current Research Progress

This paper reviewed the literature on medication rule of pulmonary nodules in recent years. It is found that contemporary doctors pay more attention to regulating Qi, clearing heat and detoxifying, eliminating phlegm, dissolving phlegm and dissipating masses. They use mild drugs, cold and warm treatments in parallel, combining the tastes of pungent, bitterness, and sweetness at the same time. The treatment focuses on the five viscera with emphasis on the lung meridian while also considering the spleen and stomach functions as well as soothing liver stagnation. This information aims to provide some reference for clinical treatment of pulmonary nodules.

Phase II Clinical Study of Three-Dimensional Printed Coplanar Template Combined with CT-Guided Percutaneous Core Needle Biopsy of Pulmonary Nodules in Elderly Patients

Background: As the population age structure gradually ages, more and more elderly people were found to have pulmonary nodules during physical examinations. Most elderly people had underlying diseases such as heart, lung, brain and blood vessels and cannot tolerate surgery. Computed tomography (CT)-guided percutaneous core needle biopsy (CNB) was the first choice for pathological diagnosis and subsequent targeted drugs, immune drugs or ablation treatment. CT-guided percutaneous CNB requires clinicians with rich CNB experience to ensure high CNB accuracy, but it was easy to cause complications such as pneumothorax and hemorrhage. Three-dimensional (3D) printing coplanar template (PCT) combined with CT-guided percutaneous pulmonary CNB biopsy has been used in clinical practice, but there was no prospective, randomized controlled study. Methods: Elderly patients with lung nodules admitted to the Department of Oncology of our hospital from January 2019 to January 2023 were selected. A total of 225 elderly patients were screened, and 30 patients were included after screening. They were randomly divided into experimental group (Group A: 30 cases) and control group (Group B: 30 cases). Group A was given 3D-PCT combined with CT-guided percutaneous pulmonary CNB biopsy, Group B underwent CT-guided percutaneous pulmonary CNB. The primary outcome measure of this study was the accuracy of diagnostic CNB, and the secondary outcome measures were CNB time, number of CNB needles, number of pathological tissues and complications. Results: The diagnostic accuracy of group A and group B was 96.67% and 76.67%, respectively (P = 0.026). There were statistical differences between group A and group B in average CNB time (P = 0.001), number of CNB (1 vs more than 1, P = 0.029), and pathological tissue obtained by CNB (3 vs 1, P = 0.040). There was no statistical difference in the incidence of pneumothorax and hemorrhage between the two groups (P > 0.05). Conclusions: 3D-PCT combined with CT-guided percutaneous CNB can improve the puncture accuracy of elderly patients, shorten the puncture time, reduce the number of punctures, and increase the amount of puncture pathological tissue, without increasing pneumothorax and hemorrhage complications. We look forward to verifying this in a phase III randomized controlled clinical study. .

Genetic susceptibility loci of lung cancer are associated with malignant risk of pulmonary nodules and improve malignancy diagnosis based on CEA levels

Objective:The heightened prevalence of pulmonary nodules(PN)has escalated its significance as a public health concern.While the precise identification of high-risk PN carriers for malignancy remains an ongoing challenge,genetic variants hold potentials as determinants of disease susceptibility that can aid in diagnosis.Yet,current understanding of the genetic loci associated with malignant PN(MPN)risk is limited.Methods:A frequency-matched case-control study was performed,comprising 247 MPN cases and 412 benign NP(BNP)controls.We genotyped 11 established susceptibility loci for lung cancer in a Chinese cohort.Loci associated with MPN risk were utilized to compute a polygenic risk score(PRS).This PRS was subsequently incorporated into the diagnostic evaluation of MPNs,with emphasis on serum tumor biomarkers.Results:Loci rs10429489G>A,rs17038564A>G,and rs12265047A>G were identified as being associated with an increased risk of MPNs.The PRS,formulated from the cumulative risk effects of these loci,correlated with the malignant risk of PNs in a dose-dependent fashion.A high PRS was found to amplify the MPN risk by 156%in comparison to a low PRS[odds ratio(OR)=2.56,95%confidence interval(95%CI),1.40−4.67].Notably,the PRS was observed to enhance the diagnostic accuracy of serum carcinoembryonic antigen(CEA)in distinguishing MPNs from BPNs,with diagnostic values rising from 0.716 to 0.861 across low-to high-PRS categories.Further bioinformatics investigations pinpointed rs10429489G>A as an expression quantitative trait locus.Conclusions:Loci rs10429489G>A,rs17038564A>G,and rs12265047A>G contribute to MPN risk and augment the diagnostic precision for MPNs based on serum CEA concentrations.

Efficacy of thoracoscopic anatomical segmentectomy for small pulmonary nodules

BACKGROUND Small pulmonary nodules are tissue shadows and thoracoscopic segmentectomy in China is still at the exploratory stage with limited application.AIM To evaluate the efficacy of thoracoscopic anatomical segmentectomy for small pulmonary nodules.METHODS Medical records of 86 patients with small pulmonary nodules treated at our hospital between August 2016 and October 2019 were retrospectively analyzed;40 cases who underwent thoracoscopic lobectomy were set as a reference group,and 46 cases who underwent thoracoscopic anatomical segmentectomy were set as an observation group.Preoperative and postoperative parameters were measured in both groups,including the percentage of forced expiratory volume in the first second(FEV1%),the percentage of forced vital capacity(FVC%),and the FEV1/FVC ratio(FEV1/FVC).Patients with positive pathological diagnosis received tests for neuron-specific enolase,carbohydrate antigen 125(CA125),CA19-9,and squamous cell carcinoma antigen.Intraoperative bleeding volume,drainage volume,the number of dissected lymph nodes,drainage time,hospital stay,treatment cost,postoperative complications,and postoperative pain condition were compared between the two groups.RESULTS No significant difference was observed in the results of four serum tumor marker(CA125,CA19-9,squamous cell carcinoma antigen,and neuron-specific enolase),the number of dissected lymph nodes,treatment cost,or preoperative pulmonary ventilation index between the two groups.Intraoperative bleeding volume,drainage volume,drainage time,hospital stay,and visual analogue scale score were significantly lower in the observation group(P<0.05).The results of FEV1%,FVC%,and FEV1/FVC were significantly higher in the observation group(P<0.05).CONCLUSION The efficacy of thoracoscopic anatomical segmentectomy and lobectomy for small pulmonary nodules shows no significant difference in terms of lesion removal,but anatomical segmentectomy is less invasive with fewer postoperative complications and less influence on lung function.

Complete Thoracoscopic Segmentectomy and Pulmonary Lobectomy in the Treatment of Small Pulmonary Nodules

Objective:To compare the clinical effect of complete thoracoscopic segmentectomy and pulmonary lobectomy for pulmonary nodules.Methods:In this study,176 patients with pulmonary nodules were treated in Changshu Hospital Affiliated to Nanjing University of Chinese Medicine from January 2019 to June 2021;according to the type of surgery,the patients were divided into group A(complete thoracoscopic segmentectomy)and group B(complete thoracoscopic pulmonary lobectomy),and the clinical effects were analyzed.Results:The intraoperative blood loss,postoperative drainage volume,postoperative hospitalization days,and lung function of patients in group A were significantly better than those in group B(P<0.05),while there was no significant difference in the number of dissected lymph nodes.Conclusion:The clinical effect of complete thoracoscopic segmentectomy for patients with small pulmonary nodules is more significant;it does not only ensure lymph node dissection,but also improve surgical-related indicators and treatment safety as well as speed up the recovery of pulmonary function.Its clinical application value is worthy of key analysis by medical institutions.

Adaptive Order Polynomial Fitting for Pulmonary Nodule Segmentation in Chest Radiograph

Segmentation of pulmonary nodules in chest radiographs is a particularly challenging task due to heavy noise and superposition of ribs,vessels,and other complicated anatomical structures in lung field. In this paper,an adaptive order polynomial fitting based raycasting algorithm is proposed for pulmonary nodule segmentation in chest radiographs. Instead of detecting nodule edge points directly,the nodule intensity profiles are first fitted by using the polynomials with adaptively determined orders. Then,the edge positions are identified through analyzing the local minimum of the fitted curves.The performance of the proposed algorithm was evaluated over an image database with 148 nodule cases in chest radiographs that were collected from a variety of digital radiograph modalities. The preliminary results show the proposed algorithm can obtain a high rate of successful segmentations.

Prospective Study of Low-and Standard-dose Chest CT for Pulmonary Nodule Detection:A Comparison of Image Quality,Size Measurements and Radiation Exposure

Objective:To comprehensively and accurately analyze the out-performance of low-dose chest CT(LDCT)vs.standard-dose CT(SDCT).Methods:The image quality,size measurements and radiation exposure for LDCT and SDCT protocols were evaluated.A total of 117 patients with extra-thoracic malignancies were prospectively enrolled for non-enhanced CT scanning using LDCT and SDCT protocols.Three experienced radiologists evaluated subjective image quality independently using a 5-point score system.Nodule detection efficiency was compared between LDCT and SDCT based on nodule characteristics(size and volume).Radiation metrics and organ doses were analyzed using Radimetrics.Results:The images acquired with the LDCT protocol yielded comparable quality to those acquired with the SDCT protocol.The sensitivity of LDCT for the detection of pulmonary nodules(n=650)was lower than that of SDCT(n=660).There was no significant difference in the diameter and volume of pulmonary nodules between LDCT and SDCT(for BMI<22 kg/m^(2),4.37 vs.4.46 mm,and 43.66 vs.46.36 mm^(3);for BMI>22 kg/m^(2),4.3 vs.4.41 mm,and 41.66 vs.44.86 mm^(3))(P>0.05).The individualized volume CT dose index(CTDI_(vol)),the size specific dose estimate and effective dose were significantly reduced in the LDCT group compared with the SDCT group(all P<0.0001).This was especially true for dose-sensitive organs such as the lung(for BMI<22 kg/m^(2),2.62 vs.12.54 mSV,and for BMI>22 kg/m^(2),1.62 vs.9.79 mSV)and the breast(for BMI<22 kg/m^(2),2.52 vs.10.93 mSV,and for BMI>22 kg/m^(2),1.53 vs.9.01 mSV)(P<0.0001).Conclusion:These results suggest that with the increases in image noise,LDCT and SDCT exhibited a comparable image quality and sensitivity.The LDCT protocol for chest scans may reduce radiation exposure by about 80% compared to the SDCT protocol.