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 an...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.展开更多
This study examined the value of volume rendering （VR） interpretation in assessing the growth of pulmonary nodular ground-glass opacity （nGGO）. A total of 47 nGGOs （average size, 9.5 mm; range, 5.7-20.6 mm） were...This study examined the value of volume rendering （VR） interpretation in assessing the growth of pulmonary nodular ground-glass opacity （nGGO）. A total of 47 nGGOs （average size, 9.5 mm; range, 5.7-20.6 mm） were observed by CT scanning at different time under identical parameter settings. The growth of nGGO was analyzed by three radiologists by comparing the thin slice （TS） CT images of initial and repeat scans with side-by-side cine mode. One week later synchronized VR images of the two scans were compared by side-by-side cine mode to evaluate the nGGO growth. The nodule growth was rated on a 5-degree scale： notable growth, slight growth, dubious growth, stagnant growth, shrinkage. Growth standard was defined as： Density increase 〉 30 HU and （or） diameter increase （by 20% in nodules 〉_10 mm, 30% in nodules of 5-9 mm）. Receiver operating characteristic （ROC） was performed. The results showed that 32 nGGOs met the growth criteria （29 nGGOs showed an increase in density; 1 nGGO showed an increase in diameter; 2 nGGOs showed an increase in both diameter and density）. Area under ROC curve revealed that the performance with VR interpretation was better than that with TS interpretation （P〈0.01, P〈0.05 and P〈0.05 for observers A, B and C respectively）. Consistency between different observers was excellent with both VR interpretation （κ=0.89 for observers A＆C A＆B, B＆C） and TS interpretation （κ=0.71 for A＆B, κ=0.68 for A＆C, κ=0.74 for B＆C）, but time spending was less with VR interpretation than with TS interpretation （P〈0.0001, P〈0.0001 and P〈0.05 for observers A, B and C, respectively）. It was concluded that VR is a useful technique for evaluating the growth of nGGO.展开更多
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 adenoc...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.展开更多
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 pr...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.展开更多
INTRODUCTION Pulmonary ground-glass shadow is a common clinical imaging manifestation shared by many pulmonary diseases such as interstitial pneumonia, pulmonary fungal infection, parasitic infection, viral pneumonia,...INTRODUCTION Pulmonary ground-glass shadow is a common clinical imaging manifestation shared by many pulmonary diseases such as interstitial pneumonia, pulmonary fungal infection, parasitic infection, viral pneumonia, and heart failure. Some of the lung cancers, especially lung adenocarcinoma,展开更多
文摘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.
基金supported by a grant from the Science and Technology Program of Guangdong Province of China(No.2009B030801120)
文摘This study examined the value of volume rendering （VR） interpretation in assessing the growth of pulmonary nodular ground-glass opacity （nGGO）. A total of 47 nGGOs （average size, 9.5 mm; range, 5.7-20.6 mm） were observed by CT scanning at different time under identical parameter settings. The growth of nGGO was analyzed by three radiologists by comparing the thin slice （TS） CT images of initial and repeat scans with side-by-side cine mode. One week later synchronized VR images of the two scans were compared by side-by-side cine mode to evaluate the nGGO growth. The nodule growth was rated on a 5-degree scale： notable growth, slight growth, dubious growth, stagnant growth, shrinkage. Growth standard was defined as： Density increase 〉 30 HU and （or） diameter increase （by 20% in nodules 〉_10 mm, 30% in nodules of 5-9 mm）. Receiver operating characteristic （ROC） was performed. The results showed that 32 nGGOs met the growth criteria （29 nGGOs showed an increase in density; 1 nGGO showed an increase in diameter; 2 nGGOs showed an increase in both diameter and density）. Area under ROC curve revealed that the performance with VR interpretation was better than that with TS interpretation （P〈0.01, P〈0.05 and P〈0.05 for observers A, B and C respectively）. Consistency between different observers was excellent with both VR interpretation （κ=0.89 for observers A＆C A＆B, B＆C） and TS interpretation （κ=0.71 for A＆B, κ=0.68 for A＆C, κ=0.74 for B＆C）, but time spending was less with VR interpretation than with TS interpretation （P〈0.0001, P〈0.0001 and P〈0.05 for observers A, B and C, respectively）. It was concluded that VR is a useful technique for evaluating the growth of nGGO.
文摘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.
文摘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.
文摘INTRODUCTION Pulmonary ground-glass shadow is a common clinical imaging manifestation shared by many pulmonary diseases such as interstitial pneumonia, pulmonary fungal infection, parasitic infection, viral pneumonia, and heart failure. Some of the lung cancers, especially lung adenocarcinoma,
