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Translational Lung Cancer Research Nov 2023Preoperative percutaneous computed tomography (CT)-guided localization of pulmonary nodules plays a pivotal role in the diagnosis and treatment of early-stage lung...
BACKGROUND
Preoperative percutaneous computed tomography (CT)-guided localization of pulmonary nodules plays a pivotal role in the diagnosis and treatment of early-stage lung cancer. However, conventional manual localization techniques have inherent limitations in achieving a high degree of accuracy. Consequently, a novel robotic-assisted navigation system was developed to attain precise localization of small lung nodules. This study aims to investigate the accuracy and safety of this system in clinical applications.
METHODS
Patients with peripheral solitary pulmonary nodules measuring less than 20 mm were enrolled. The robotic-assisted navigation system generated a three-dimensional (3D) model based on the patient's CT images, determining the optimal puncture path. The robotic arm then accurately located the nodule and, following percutaneous puncture, indocyanine green (ICG) was injected. The primary outcome measure was the accuracy of pulmonary nodule localization, while secondary outcomes included the complication rate, procedural duration, and total radiation exposure.
RESULTS
A total of 33 nodules were successfully localized using the robotic-assisted navigation system and resected through video-assisted thoracoscopic surgery (VATS). The first-pass success rate was 100%, with a median deviation of 6.1 mm [interquartile range (IQR), 2.5-7.2 mm] between the localizer and the nodule. The median localization time was 25.0 minutes, and the single and cumulative exam dose-length products (DLP) were 534.0 and 1491.0 mGy·cm, respectively. Notably, no observable complications were reported during the procedures.
CONCLUSIONS
The innovative robotic-assisted navigation system demonstrated satisfactory accuracy and holds promise for improving the percutaneous localization of lung nodules. This method represents a safe and viable alternative to traditional CT-guided manual localization techniques.
PubMed: 38090522
DOI: 10.21037/tlcr-23-493 -
Journal of X-ray Science and Technology 2024The accurate classification of pulmonary nodules has great application value in assisting doctors in diagnosing conditions and meeting clinical needs. However, the...
BACKGROUND
The accurate classification of pulmonary nodules has great application value in assisting doctors in diagnosing conditions and meeting clinical needs. However, the complexity and heterogeneity of pulmonary nodules make it difficult to extract valuable characteristics of pulmonary nodules, so it is still challenging to achieve high-accuracy classification of pulmonary nodules.
OBJECTIVE
In this paper, we propose a local-global hybrid network (LGHNet) to jointly model local and global information to improve the classification ability of benign and malignant pulmonary nodules.
METHODS
First, we introduce the multi-scale local (MSL) block, which splits the input tensor into multiple channel groups, utilizing dilated convolutions with different dilation rates and efficient channel attention to extract fine-grained local information at different scales. Secondly, we design the hybrid attention (HA) block to capture long-range dependencies in spatial and channel dimensions to enhance the representation of global features.
RESULTS
Experiments are carried out on the publicly available LIDC-IDRI and LUNGx datasets, and the accuracy, sensitivity, precision, specificity, and area under the curve (AUC) of the LIDC-IDRI dataset are 94.42%, 94.25%, 93.05%, 92.87%, and 97.26%, respectively. The AUC on the LUNGx dataset was 79.26%.
CONCLUSION
The above classification results are superior to the state-of-the-art methods, indicating that the network has better classification performance and generalization ability.
Topics: Humans; Lung Neoplasms; Solitary Pulmonary Nodule; Neural Networks, Computer; Tomography, X-Ray Computed; Algorithms; Lung; Sensitivity and Specificity
PubMed: 38277335
DOI: 10.3233/XST-230291 -
Clinics in Chest Medicine Jun 2024Subsolid nodules are heterogeneously appearing and behaving entities, commonly encountered incidentally and in high-risk populations. Accurate characterization of... (Review)
Review
Subsolid nodules are heterogeneously appearing and behaving entities, commonly encountered incidentally and in high-risk populations. Accurate characterization of subsolid nodules, and application of evolving surveillance guidelines, facilitates evidence-based and multidisciplinary patient-centered management.
Topics: Humans; Lung Neoplasms; Solitary Pulmonary Nodule; Multiple Pulmonary Nodules; Diagnosis, Differential
PubMed: 38816087
DOI: 10.1016/j.ccm.2024.02.003 -
Pulmonology 2024Multidisciplinary nodule clinics provide high-quality care and favor adherence to guidelines. Virtual care has shown savings benefits along with patient satisfaction.... (Observational Study)
Observational Study
INTRODUCTION AND OBJECTIVES
Multidisciplinary nodule clinics provide high-quality care and favor adherence to guidelines. Virtual care has shown savings benefits along with patient satisfaction. Our aim is to describe the first year of operation of a multidisciplinary virtual lung nodule clinic, the population evaluated and issued decisions. Secondarily, among discharged patients, we aimed to analyze their follow-up prior to the existence of our consultation, evaluating its adherence to guidelines.
MATERIALS AND METHODS
Observational study including all patients evaluated at the Virtual Lung Nodule Clinic (VLNC) (March 2018- March 2019). Clinical and radiological data were recorded. Recommendations, based on 2017 Fleischner Society guidelines, were categorized into follow-up, discharge or referral to lung cancer consultation. Discharged patients were classified according to adherence to guidelines of their previous management, into adequate, prolonged and non-indicated follow-up.
RESULTS
A total of 365 patients (58.9% men; median age 64.0 years) were included. Sixty-four percent had smoking history and 23% had chronic obstructive pulmonary disease (COPD). Most nodules were solid (87.4%) and multiple (57.5%). The median diameter was 6.00 mm. 43.8% of patients were discharged following first VLNC evaluation. Among them, 27.5% had received appropriate follow-up, but 66.9% had received poor management. Patients with prolonged follow-up (33.1%) were older (67.0 vs 60.5 years) and had larger nodules (6.00 mm vs 5.00). Non-indicated follow-up patients (33.8%) were more non-smokers (77.8% vs 31.8%) and presented smaller nodules (4.00 vs 5.00 mm).
CONCLUSIONS
During its first year of operation, the VLNC has evaluated a population with a relevant risk profile for lung cancer development, management of which should be cautious and adhere to guidelines. After the first VLNC assessment, approximately one-half of this population was discharged. It was noticeable that previous follow-up of discharged patients was found poorly adherent to guidelines, with a marked tendency to overmanagement.
Topics: Humans; Male; Female; Middle Aged; Aged; Lung Neoplasms; Guideline Adherence; Solitary Pulmonary Nodule; Multiple Pulmonary Nodules; Telemedicine; Referral and Consultation; Patient Care Team; Pulmonary Disease, Chronic Obstructive
PubMed: 35115280
DOI: 10.1016/j.pulmoe.2021.12.003 -
Chest Mar 2024The American College of Radiology created the Lung CT Screening Reporting and Data System (Lung-RADS) in 2014 to standardize the reporting and management of...
The American College of Radiology created the Lung CT Screening Reporting and Data System (Lung-RADS) in 2014 to standardize the reporting and management of screen-detected pulmonary nodules. Lung-RADS was updated to version 1.1 in 2019 and revised size thresholds for nonsolid nodules, added classification criteria for perifissural nodules, and allowed for short-interval follow-up of rapidly enlarging nodules that may be infectious in etiology. Lung-RADS v2022, released in November 2022, provides several updates including guidance on the classification and management of atypical pulmonary cysts, juxtapleural nodules, airway-centered nodules, and potentially infectious findings. This new release also provides clarification for determining nodule growth and introduces stepped management for nodules that are stable or decreasing in size. This article summarizes the current evidence and expert consensus supporting Lung-RADS v2022.
Topics: Humans; Lung Neoplasms; Tomography, X-Ray Computed; Multiple Pulmonary Nodules; Consensus; Lung; Thyroid Nodule; Retrospective Studies; Ultrasonography
PubMed: 38300206
DOI: 10.1016/j.chest.2023.10.028 -
BMC Medical Imaging Nov 2023Pulmonary nodule growth rate assessment is critical in the management of subsolid pulmonary nodules (SSNs) during clinical follow-up. The present study aimed to develop...
BACKGROUND
Pulmonary nodule growth rate assessment is critical in the management of subsolid pulmonary nodules (SSNs) during clinical follow-up. The present study aimed to develop a model to predict the growth rate of SSNs.
METHODS
A total of 273 growing SSNs with clinical information and 857 computed tomography (CT) scans were retrospectively analyzed. The images were randomly divided into training and validation sets. All images were categorized into fast-growth (volume doubling time (VDT) ≤ 400 days) and slow-growth (VDT > 400 days) groups. Models for predicting the growth rate of SSNs were developed using radiomics and clinical features. The models' performance was evaluated using the area under the curve (AUC) values for the receiver operating characteristic curve.
RESULTS
The fast- and slow-growth groups included 108 and 749 scans, respectively, and 10 radiomics features and three radiographic features (nodule density, presence of spiculation, and presence of vascular changes) were selected to predict the growth rate of SSNs. The nomogram integrating radiomics and radiographic features (AUC = 0.928 and AUC = 0.905, respectively) performed better than the radiographic (AUC = 0.668 and AUC = 0.689, respectively) and radiomics (AUC = 0.888 and AUC = 0.816, respectively) models alone in both the training and validation sets.
CONCLUSION
The nomogram model developed by combining radiomics with radiographic features can predict the growth rate of SSNs more accurately than traditional radiographic models. It can also optimize clinical treatment decisions for patients with SSNs and improve their long-term management.
Topics: Humans; Lung Neoplasms; Retrospective Studies; ROC Curve; Nomograms; Tomography, X-Ray Computed
PubMed: 37936095
DOI: 10.1186/s12880-023-01143-x -
Computers in Biology and Medicine Oct 2023CAD systems for lung cancer diagnosis and detection can significantly offer unbiased, infatiguable diagnostics with minimal variance, decreasing the mortality rate and... (Review)
Review
CAD systems for lung cancer diagnosis and detection can significantly offer unbiased, infatiguable diagnostics with minimal variance, decreasing the mortality rate and the five-year survival rate. Lung segmentation and lung nodule detection are critical steps in the lung cancer CAD system pipeline. Literature on lung segmentation and lung nodule detection mostly comprises techniques that process 3-D volumes or 2-D slices and surveys. However, surveys that highlight 2.5D techniques for lung segmentation and lung nodule detection still need to be included. This paper presents a background and discussion on 2.5D methods to fill this gap. Further, this paper also gives a taxonomy of 2.5D approaches and a detailed description of the 2.5D approaches. Based on the taxonomy, various 2.5D techniques for lung segmentation and lung nodule detection are clustered into these 2.5D approaches, which is followed by possible future work in this direction.
Topics: Humans; Lung Neoplasms; Thorax; Lung; Tomography, X-Ray Computed
PubMed: 37717526
DOI: 10.1016/j.compbiomed.2023.107437 -
Thoracic Surgery Clinics Aug 2023Lung cancer remains the leading cause of cancer-related deaths. Early tissue diagnosis followed by timely therapeutic procedures can have a significant impact on overall... (Review)
Review
Lung cancer remains the leading cause of cancer-related deaths. Early tissue diagnosis followed by timely therapeutic procedures can have a significant impact on overall survival. While robotic-assisted lung resection is an established therapeutic procedure, robotic-assisted bronchoscopy is a more recent diagnostic procedure that improves reach, stability, and precision in the field of bronchoscopic lung nodule biopsy. The ability to combine lung cancer diagnostics with therapeutic surgical resection into a single-setting anesthesia procedure has the potential to decrease costs, improve patient experiences, and most importantly, reduce delays in cancer care.
Topics: Humans; Robotic Surgical Procedures; Solitary Pulmonary Nodule; Lung Neoplasms; Lung; Biopsy; Bronchoscopy
PubMed: 37414479
DOI: 10.1016/j.thorsurg.2023.04.009 -
Radiologia 2023To describe the epidemiology and CT findings for nontuberculous mycobacterial lung infections and outcomes depending on the treatment.
OBJECTIVE
To describe the epidemiology and CT findings for nontuberculous mycobacterial lung infections and outcomes depending on the treatment.
MATERIAL AND METHODS
We retrospectively studied 131 consecutive patients with positive cultures for nontuberculous mycobacteria between 2005 and 2016. We selected those who met the criteria for nontuberculous mycobacterial lung infection. We analysed the epidemiologic data; clinical, microbiological, and radiological findings; treatment; and outcome according to treatment.
RESULTS
We included 34 patients (mean age, 55 y; 67.6% men); 50% were immunodepressed (58.8% of these were HIV+), 20.6% had COPD, 5.9% had known tumors, 5.9% had cystic fibrosis, and 29.4% had no comorbidities. We found that 20.6% had a history of tuberculosis and 20.6% were also infected with other microorganisms. Mycobacterium avium complex was the most frequently isolated germ (52.9%); 7 (20.6%) were also infected with other organisms. The most common CT findings were nodules (64.7%), tree-in-bud pattern (61.8%), centrilobular nodules (44.1 %), consolidations (41.2%), bronchiectasis (35.3%), and cavities (32.4%). We compared findings between men and women and between immunodepressed and immunocompetent patients. Treatment was antituberculosis drugs in 67.6% of patients (72% of whom showed improvement) and conventional antibiotics in 20.6% (all of whom showed radiologic improvement).
CONCLUSION
The diagnosis of nontuberculous mycobacterial lung infections is complex. The clinical and radiologic findings are nonspecific and a significant percentage of pateints can have other, concomitant infections.
Topics: Male; Humans; Female; Middle Aged; Nontuberculous Mycobacteria; Mycobacterium Infections, Nontuberculous; Retrospective Studies; Cystic Fibrosis; Pneumonia; Antitubercular Agents; Lung
PubMed: 37758330
DOI: 10.1016/j.rxeng.2023.09.001 -
Kardiochirurgia I Torakochirurgia... Dec 2023In the modern era when screening and early surveillance of pulmonary nodules are increasing in importance, the management of the pulmonary nodule represents a different... (Review)
Review
In the modern era when screening and early surveillance of pulmonary nodules are increasing in importance, the management of the pulmonary nodule represents a different challenge to thoracic surgeons. The difficulty lies in the merging of sound surgical and oncological principles with more minimally invasive and appropriate lung-sparing surgery. The success rates of video-assisted thoracoscopic surgery (VATS) resection for smaller as well as subsolid nodules have increased as a result of radiologists' preoperative localization tools. Fast tracking in thoracic surgery is promoted by proper postoperative care for patients having lobectomies in combination with the VATS technique. Image-guided surgery refers to the application of a real-time correlation of the surgical field to preoperative imaging data collection that reflects the precise placement of a chosen surgical instrument in the adjacent anatomic structures. Among the cross-sectional digital imaging techniques the most widely utilized imaging modalities for image-guided therapy are computed tomography and magnetic resonance imaging. Additionally, surgical navigation devices, tracking tools, integration software, ultrasound, and angiography are used to support these procedures. For people who are thinking about implementing or optimizing a nodule localization program in view of workflow patterns, surgeon preferences, and institutional resources in a certain facility, this review provides in-depth, unbiased evaluation and offers useful information.
PubMed: 38283561
DOI: 10.5114/kitp.2023.134162