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The Lancet. Digital Health Sep 2023Mediastinal neoplasms are typical thoracic diseases with increasing incidence in the general global population and can lead to poor prognosis. In clinical practice, the...
BACKGROUND
Mediastinal neoplasms are typical thoracic diseases with increasing incidence in the general global population and can lead to poor prognosis. In clinical practice, the mediastinum's complex anatomic structures and intertype confusion among different mediastinal neoplasm pathologies severely hinder accurate diagnosis. To solve these difficulties, we organised a multicentre national collaboration on the basis of privacy-secured federated learning and developed CAIMEN, an efficient chest CT-based artificial intelligence (AI) mediastinal neoplasm diagnosis system.
METHODS
In this multicentre cohort study, 7825 mediastinal neoplasm cases and 796 normal controls were collected from 24 centres in China to develop CAIMEN. We further enhanced CAIMEN with several novel algorithms in a multiview, knowledge-transferred, multilevel decision-making pattern. CAIMEN was tested by internal (929 cases at 15 centres), external (1216 cases at five centres and a real-world cohort of 11 162 cases), and human-AI (60 positive cases from four centres and radiologists from 15 institutions) test sets to evaluate its detection, segmentation, and classification performance.
FINDINGS
In the external test experiments, the area under the receiver operating characteristic curve for detecting mediastinal neoplasms of CAIMEN was 0·973 (95% CI 0·969-0·977). In the real-world cohort, CAIMEN detected 13 false-negative cases confirmed by radiologists. The dice score for segmenting mediastinal neoplasms of CAIMEN was 0·765 (0·738-0·792). The mediastinal neoplasm classification top-1 and top-3 accuracy of CAIMEN were 0·523 (0·497-0·554) and 0·799 (0·778-0·822), respectively. In the human-AI test experiments, CAIMEN outperformed clinicians with top-1 and top-3 accuracy of 0·500 (0·383-0·633) and 0·800 (0·700-0·900), respectively. Meanwhile, with assistance from the computer aided diagnosis software based on CAIMEN, the 46 clinicians improved their average top-1 accuracy by 19·1% (0·345-0·411) and top-3 accuracy by 13·0% (0·545-0·616).
INTERPRETATION
For mediastinal neoplasms, CAIMEN can produce high diagnostic accuracy and assist the diagnosis of human experts, showing its potential for clinical practice.
FUNDING
National Key R&D Program of China, National Natural Science Foundation of China, and Beijing Natural Science Foundation.
Topics: Humans; Mediastinal Neoplasms; Mediastinum; Artificial Intelligence; Cohort Studies; Diagnosis, Computer-Assisted
PubMed: 37625894
DOI: 10.1016/S2589-7500(23)00106-1 -
Chest Oct 2005Tumors of the mediastinum represent a wide diversity of disease states. The location and composition of a mass is critical to narrowing the differential diagnosis. The... (Review)
Review
Tumors of the mediastinum represent a wide diversity of disease states. The location and composition of a mass is critical to narrowing the differential diagnosis. The most common causes of an anterior mediastinal mass include the following: thymoma; teratoma; thyroid disease; and lymphoma. Masses of the middle mediastinum are typically congenital cysts, including foregut and pericardial cysts, while those that arise in the posterior mediastinum are often neurogenic tumors. The clinical sequelae of mediastinal masses can range from being asymptomatic to producing symptoms of cough, chest pain, and dyspnea. This article will review the anatomy of the mediastinum as well as the different clinical, radiographic, and prognostic features, and therapeutic options of the most commonly encountered masses.
Topics: Diagnosis, Differential; Humans; Lymphoma; Mediastinal Neoplasms; Neoplasm Staging; Teratoma; Thymoma; Thymus Neoplasms; Thyroid Neoplasms
PubMed: 16236967
DOI: 10.1378/chest.128.4.2893 -
Perfusion Mar 2019A 90-year-old female patient presented to the emergency department with abdominal pain. Computed tomography (CT) set the suspicion of a cardiac tumor in the right heart...
A 90-year-old female patient presented to the emergency department with abdominal pain. Computed tomography (CT) set the suspicion of a cardiac tumor in the right heart chambers. We describe the presentation, the differential diagnosis and the decision for management of the patient.
Topics: Aged, 80 and over; Female; Humans; Mediastinal Neoplasms; Myocardium
PubMed: 30289353
DOI: 10.1177/0267659118803823 -
European Journal of Cardio-thoracic... May 2014Accurate preoperative staging and restaging of mediastinal lymph nodes in patients with potentially resectable non-small-cell lung cancer (NSCLC) is of paramount...
Accurate preoperative staging and restaging of mediastinal lymph nodes in patients with potentially resectable non-small-cell lung cancer (NSCLC) is of paramount importance. In 2007, the European Society of Thoracic Surgeons (ESTS) published an algorithm on preoperative mediastinal staging integrating imaging, endoscopic and surgical techniques. In 2009, the International Association for the Study of Lung Cancer (IASLC) introduced a new lymph node map. Some changes in this map have an important impact on mediastinal staging. Moreover, more evidence of the different mediastinal staging technique has become available. Therefore, a revision of the ESTS guidelines was needed. In case of computed tomography (CT)-enlarged or positron emission tomography (PET)-positive mediastinal lymph nodes, tissue confirmation is indicated. Endosonography [endobronchial ultrasonography (EBUS)/esophageal ultrasonography (EUS)] with fine-needle aspiration (FNA) is the first choice (when available), since it is minimally invasive and has a high sensitivity to rule in mediastinal nodal disease. If negative, surgical staging with nodal dissection or biopsy is indicated. Video-assisted mediastinoscopy is preferred to mediastinoscopy. The combined use of endoscopic staging and surgical staging results in the highest accuracy. When there are no enlarged lymph nodes on CT and when there is no uptake in lymph nodes on PET or PET-CT, direct surgical resection with systematic nodal dissection is indicated for tumours ≤ 3 cm located in the outer third of the lung. In central tumours or N1 nodes, preoperative mediastinal staging is indicated. The choice between endoscopic staging with EBUS/EUS and FNA or video-assisted mediastinoscopy depends on local expertise to adhere to minimal requirements for staging. For tumours >3 cm, preoperative mediastinal staging is advised, mainly in adenocarcinoma with high standardized uptake value. For restaging, invasive techniques providing histological information are advisable. Both endoscopic techniques and surgical procedures are available, but their negative predictive value is lower compared with the results obtained in baseline staging. An integrated strategy using endoscopic staging techniques to prove mediastinal nodal disease and mediastinoscopy to assess nodal response after induction therapy needs further study.
Topics: Algorithms; Carcinoma, Non-Small-Cell Lung; Humans; Lung Neoplasms; Lymph Nodes; Mediastinal Neoplasms; Neoplasm Staging; Thoracoscopy
PubMed: 24578407
DOI: 10.1093/ejcts/ezu028 -
Acta Cardiologica Aug 2017
Topics: Aged; Antigens, CD34; Biomarkers, Tumor; Cell Dedifferentiation; Chemoradiotherapy; Humans; Immunohistochemistry; Incidental Findings; Liposarcoma; Male; Mediastinal Neoplasms; Neoplasm Recurrence, Local; Positron Emission Tomography Computed Tomography; Proto-Oncogene Proteins c-mdm2
PubMed: 28707566
DOI: 10.1080/00015385.2017.1335460 -
Critical Reviews in Oncology/hematology May 2017Primary mediastinal large B-cell lymphoma (PMLBCL) is a distinct clinical and biological disease from other types of DLBCL. It is more frequent in young female and... (Review)
Review
Primary mediastinal large B-cell lymphoma (PMLBCL) is a distinct clinical and biological disease from other types of DLBCL. It is more frequent in young female and constitutes 6%-10% of all DLBCL. PMLBCL is characterized by a diffuse proliferation of medium to large B-cells associated with sclerosis. Molecular analysis shows it to be a distinct entity from other DLBCL. Rituximab CHOP/MACOP-B-like regimens followed by mediastinal radiotherapy (RT) were associated with a 5-years PFS of 75%-85%. More intensive regimens, as DA-EPOCH-R without mediastinal RT, have shown very promising results, but this therapeutic advance needs to be confirmed in further prospective trials. The role of consolidative mediastinal RT should be still better assess in prospective comparative studies. PET-CT scan is a powerful tool to define the real quality of response and it is hoped that future prospective trials may allow its role in the de-escalation of mediastinal RT.
Topics: Antineoplastic Combined Chemotherapy Protocols; Humans; Lymphoma, Large B-Cell, Diffuse; Mediastinal Neoplasms; Neoplasm Staging; Positron Emission Tomography Computed Tomography; Prognosis
PubMed: 28318892
DOI: 10.1016/j.critrevonc.2017.01.009 -
Seminars in Diagnostic Pathology Jan 2023Mediastinal germ cell tumors share similar histopathological, immunohistochemical, and molecular features with their counterparts in the gonads. Therefore, proper... (Review)
Review
Mediastinal germ cell tumors share similar histopathological, immunohistochemical, and molecular features with their counterparts in the gonads. Therefore, proper clinical and radiological evaluation of patients with an anterior mediastinal mass becomes essential in the final interpretation of these tumors. The gold standard for the diagnosis of these tumors remains histopathological evaluation. However, immunohistochemical stains and molecular studies also provide an aid in cases in which the histology is not typical. It is also important to keep in mind that a small mediastinoscopic biopsy may not be representative of the entire neoplasm. In this review, we will provide our perspective regarding histopathological diagnosis, staging, immunohistochemical and molecular profile, and briefly family of tumors address pertinent epidemiological, clinical and treatment options. However, the main emphasis is to review the process of pathological assessment in pre and post-treated tumors. Knowledge of the different growth patterns and histological associations is important, mainly when confronted with mediastinoscopic biopsies, which ultimately will determine treatment options.
Topics: Humans; Neoplasms, Germ Cell and Embryonal; Mediastinal Neoplasms; Biopsy
PubMed: 35717316
DOI: 10.1053/j.semdp.2022.06.010 -
Cancer Treatment Reviews Jun 2015The management of primary mediastinal large B-cell lymphoma (PMBCL) requires a balance between optimizing chances of cure and reducing risk of long-term toxicities. The... (Review)
Review
The management of primary mediastinal large B-cell lymphoma (PMBCL) requires a balance between optimizing chances of cure and reducing risk of long-term toxicities. The combination of rituximab to cyclophosphamide, doxorubicin, vincristine and prednisone (RCHOP) followed by mediastinal radiation results in a plateau in progression-free survival after first few years of follow-up. In rituximab era, a negative positron emission tomography (PET) scan performed after the completion of immunochemotherapy has a high predictive value for durable remission. Consequently, end-of-therapy PET may be utilizable to avoid radiation without compromising survival. Additionally, intensified chemotherapy alone has shown excellent survival. PMBCL is frequently associated with amplification of programmed death ligand (PDL) 1/2 and constitutive activation of JAK-STAT and NFKB pathways; these may serve as promising therapeutic targets. Clinical trials that integrate novel therapies into upfront immunochemotherapy and utilize end-of-therapy PET scan to guide mediastinal radiation have potential to further enhance survival and prevent long-term toxicities.
Topics: Adult; Antineoplastic Combined Chemotherapy Protocols; Female; Humans; Lymphoma, Large B-Cell, Diffuse; Male; Mediastinal Neoplasms; Neoplasm Staging; Positron-Emission Tomography; Salvage Therapy
PubMed: 25913715
DOI: 10.1016/j.ctrv.2015.04.006 -
European Journal of Cardio-thoracic... May 2022Mediastinal arterio-venous haemangiomas are rare benign vascular tumours. To the best of our knowledge, very few cases of mediastinal arterio-venous haemangiomas have...
Mediastinal arterio-venous haemangiomas are rare benign vascular tumours. To the best of our knowledge, very few cases of mediastinal arterio-venous haemangiomas have ever been reported. Herein, we report about a 55-year-old woman who presented to our hospital with a mass in the right posterior mediastinum. The tumour was successfully resected via video-assisted thoracoscopic surgery, and further pathological analysis confirmed the mass to be an arterio-venous haemangioma. The patient made a full recovery without any postoperative complications.
Topics: Arteriovenous Malformations; Female; Hemangioma; Humans; Mediastinal Neoplasms; Mediastinum; Middle Aged; Thoracic Surgery, Video-Assisted
PubMed: 34986218
DOI: 10.1093/ejcts/ezab566 -
Revista Portuguesa de Pneumologia 2006Mediastinal lymphangioma is a rare vascular neoplasm, accounting for 0.7 to 4.5% of all the mediastinum tumors. It is a benign tumor, generally occur- ring as a...
Mediastinal lymphangioma is a rare vascular neoplasm, accounting for 0.7 to 4.5% of all the mediastinum tumors. It is a benign tumor, generally occur- ring as a mediastinal mass of slow growth. Most patients are asymptomatic, being incidentally diagnosed after a routine chest radiograph. The best treatment consists of complete surgical resection. Prognosis depends on the degree of resectability, and recurrence is not expected if the lesion is totally removed.
Topics: Adult; Humans; Lymphangioma, Cystic; Male; Mediastinal Neoplasms
PubMed: 17301927
DOI: No ID Found