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BMC Infectious Diseases Jun 2024In this study, we examined the value of chest CT signs combined with peripheral blood eosinophil percentage in differentiating between pulmonary paragonimiasis and...
OBJECTIVE
In this study, we examined the value of chest CT signs combined with peripheral blood eosinophil percentage in differentiating between pulmonary paragonimiasis and tuberculous pleurisy in children.
METHODS
Patients with pulmonary paragonimiasis and tuberculous pleurisy were retrospectively enrolled from January 2019 to April 2023 at the Kunming Third People's Hospital and Lincang People's Hospital. There were 69 patients with pulmonary paragonimiasis (paragonimiasis group) and 89 patients with tuberculous pleurisy (tuberculosis group). Clinical symptoms, chest CT imaging findings, and laboratory test results were analyzed. Using binary logistic regression, an imaging model of CT signs and a combined model of CT signs and eosinophils were developed to calculate and compare the differential diagnostic performance of the two models.
RESULTS
CT signs were used to establish the imaging model, and the receiver operating characteristic (ROC) curve was plotted. The area under the curve (AUC) was 0.856 (95% CI: 0.799-0.913), the sensitivity was 66.7%, and the specificity was 88.9%. The combined model was established using the CT signs and eosinophil percentage, and the ROC was plotted. The AUC curve was 0.950 (95% CI: 0.919-0.980), the sensitivity was 89.9%, and the specificity was 90.1%. The differential diagnostic efficiency of the combined model was higher than that of the imaging model, and the difference in AUC was statistically significant.
CONCLUSION
The combined model has a higher differential diagnosis efficiency than the imaging model in the differentiation of pulmonary paragonimiasis and tuberculous pleurisy in children. The presence of a tunnel sign on chest CT, the absence of pulmonary nodules, and an elevated percentage of peripheral blood eosinophils are indicative of pulmonary paragonimiasis in children.
Topics: Humans; Eosinophils; Paragonimiasis; Male; Female; Child; Retrospective Studies; Diagnosis, Differential; Tuberculosis, Pleural; Tomography, X-Ray Computed; Child, Preschool; Adolescent; ROC Curve; Sensitivity and Specificity
PubMed: 38851671
DOI: 10.1186/s12879-024-09461-3 -
Indian Journal of Pathology &... Jun 2024Angiosarcoma is a rare soft tissue sarcoma. Primary angiosarcoma of the lung is even rarer. This case presents a patient with hemoptysis for 3 months. A chest computed...
Angiosarcoma is a rare soft tissue sarcoma. Primary angiosarcoma of the lung is even rarer. This case presents a patient with hemoptysis for 3 months. A chest computed tomography (CT) showed multiple patches of nodules with peripheral exudates distributed along the vascular bundles in both lungs, and the biopsy suggested IgG4 disease. However, the hemoptysis worsened for 3 days, and the patient underwent partial resection of the left upper lung, revealing eight masses of 0.5-2 cm in diameter. The tumor was composed of spindle, round, or polygonal cells arranged in bundles or sheets, and tumor cells were positive for vascular tumor markers. The patient was treated with six cycles of paclitaxel combined with gemcitabine chemotherapy, reducing the volume of the masses and improving hemoptysis.
PubMed: 38847188
DOI: 10.4103/ijpm.ijpm_794_23 -
Skin Health and Disease Jun 2024Excoriated pruritus can be an intolerable symptom in patients with cancer where Type 2 inflammation and its associated cytokines IL-4 and IL-13 play major roles in the...
Excoriated pruritus can be an intolerable symptom in patients with cancer where Type 2 inflammation and its associated cytokines IL-4 and IL-13 play major roles in the pruritus. Dupilumab, an antibody blocking IL-4 and IL-13, is approved for treating moderate to severe atopic dermatitis (AD) where itching is a significant symptom. We present a case report of intractable malignancy-associated AD and pruritus with eosinophilia in a patient with stage IV malignant melanoma who was treated with dupilumab. Biweekly treatment with dupilumab led to an immediate improvement in itching and resolution of the AD, which subsided after a few doses and without significant adverse effects. Routine radiologic monitoring of the malignant melanoma showed concomitant resolution of secondary nodules in the lung, liver, and pleura. It was concluded that dupilumab may be a safe and effective treatment for intractable malignancy-associated AD with pruritus and may have potential for moderating metastatic malignant melanoma.
PubMed: 38846700
DOI: 10.1002/ski2.362 -
Quantitative Imaging in Medicine and... Jun 2024Melioidosis pneumonia, caused by the bacterium , is a serious infectious disease prevalent in tropical regions. Chest computed tomography (CT) has emerged as a valuable...
BACKGROUND
Melioidosis pneumonia, caused by the bacterium , is a serious infectious disease prevalent in tropical regions. Chest computed tomography (CT) has emerged as a valuable tool for assessing the severity and progression of lung involvement in melioidosis pneumonia. However, there persists a need for the quantitative assessment of CT characteristics and staging methodologies to precisely anticipate disease progression. This study aimed to quantitatively extract CT features and evaluate a CT score-based staging system in predicting the progression of melioidosis pneumonia.
METHODS
This study included 97 patients with culture-confirmed melioidosis pneumonia who presented between January 2002 and December 2021. Lung segmentation and annotation of lesions (consolidation, nodules, and cavity) were used for feature extraction. The features, including the involved area, amount, and intensity, were extracted. The CT scores of the lesion features were defined by the feature importance weight and qualitative stage of melioidosis pneumonia. Gaussian process regression (GPR) was used to predict patients with severe or critical melioidosis pneumonia according to CT scores.
RESULTS
The melioidosis pneumonia stages included acute stage (0-7 days), subacute stage (8-28 days), and chronic stage (>28 days). In the acute stage, the CT scores of all patients ranged from 2.5 to 6.5. In the subacute stage, the CT scores for the severe and mild patients were 3.0-7.0 and 2.0-5.0, respectively. In the chronic stage, the CT score of the mild patients fluctuated approximately between 2.5 and 3.5 in a linear distribution. Consolidation was the most common type of lung lesion in those with melioidosis pneumonia. Between stages I and II, the percentage of severe scans with nodules dropped from 72.22% to 47.62% (P<0.05), and the percentage of severe scans with cavities significantly increased from 16.67% to 57.14% (P<0.05). The GPR optimization function yielded area under the receiver operating characteristic curves of 0.71 for stage I, 0.92 for stage II, and 0.87 for all stages.
CONCLUSIONS
In patients with melioidosis pneumonia, it is reasonable to divide the period (the whole progression of melioidosis pneumonia) into three stages to determine the prognosis.
PubMed: 38846316
DOI: 10.21037/qims-23-1476 -
Quantitative Imaging in Medicine and... Jun 2024Radiomics models based on computed tomography (CT) can be used to differentiate invasive ground-glass nodules (GGNs) in lung adenocarcinoma to help determine the optimal...
Development and validation of an interpretable delta radiomics-based model for predicting invasive ground-glass nodules in lung adenocarcinoma: a retrospective cohort study.
BACKGROUND
Radiomics models based on computed tomography (CT) can be used to differentiate invasive ground-glass nodules (GGNs) in lung adenocarcinoma to help determine the optimal timing of GGN resection, improve the accuracy of prognostic prediction, and reduce unnecessary surgeries. However, general radiomics does not fully utilize follow-up data and often lacks model interpretation. Therefore, this study aimed to build an interpretable model based on delta radiomics to predict GGN invasiveness.
METHODS
A retrospective analysis was conducted on a set of 303 GGNs that were surgically resected and confirmed as lung adenocarcinoma in Shanghai Chest Hospital between September 2017 and August 2022. Delta radiomics and general radiomics features were extracted from preoperative follow-up CT scans and combined with clinical features for modeling. The performance of the delta radiomics-clinical model was compared to that of the radiomics-clinical model. Additionally, Shapley additive explanations (SHAP) was employed to interpret and visualize the model.
RESULTS
Two models were constructed using a combination of 34 radiomic features and 10 delta radiomic features, along with 14 clinical features. The radiomics-clinical model and the delta radiomics-clinical model exhibited area under the curve (AUC) of 0.986 [95% confidence interval (CI): 0.977-0.995] and 0.974 (95% CI: 0.959-0.987) in the training set, respectively, and 0.949 (95% CI: 0.908-0.978) and 0.927 (95% CI: 0.879-0.966) in the test set, respectively. The DeLong test of the two models showed no statistical significance (P=0.10) in the test set. SHAP was used to output a summary plot for global interpretation, which showed that preoperative mass, three-dimensional (3D) length, mean diameter, volume, mean CT value, and delta radiomics feature original_firstorder_RootMeanSquared were the relatively more important features in the model. Waterfall plots for local interpretation showed how each feature contributed to the prediction output of a given GGN.
CONCLUSIONS
The delta radiomics-based model proved to be a helpful tool for predicting the invasiveness of GGNs in lung adenocarcinoma. This approach offers a precise, noninvasive alternative in informing clinical decision-making. Additionally, SHAP provided insightful and user-friendly interpretations and visualizations of the model, enhancing its clinical applicability.
PubMed: 38846292
DOI: 10.21037/qims-23-1711 -
Quantitative Imaging in Medicine and... Jun 2024Prediction of subsolid nodule (SSN) interval growth is crucial for clinical management and decision making in lung cancer screening program. To the best of our...
BACKGROUND
Prediction of subsolid nodule (SSN) interval growth is crucial for clinical management and decision making in lung cancer screening program. To the best of our knowledge, no study has investigated whether volume doubling time (VDT) is an independent factor for predicting SSN interval growth, or whether its predictive power is better than that of traditional semantic methods, such as nodular diameter or type. This study aimed to investigate whether VDT could provide added value in predicting the long-term natural course of SSNs (<3 cm) regarding stage shift.
METHODS
This retrospective study enrolled 132 patients with spectrum lesions of lung adenocarcinoma who underwent two consecutive computed tomography (CT) examinations before surgical tissue proofing between 2012 and 2021 in Kaohsiung Veterans General Hospital. The VDTs were manually calculated from the volumetric segmentation using Schwartz's approximation formula. We utilized logistic regression to identify predictors associated with stage shift progression based on the VDT parameter.
RESULTS
The average duration of follow-up period was 3.629 years. A VDT-based nomogram model (model 2) based on CT semantic features, clinical characteristics, and the VDT parameter yielded an area under the curve (AUC) of 0.877 [95% confidence interval (CI): 0.807-0.928]. Compared with model 1 (CT semantic features and clinical characteristics), model 2 exhibited the better predictive performance for stage shift (AUC model 1: 0.833 versus AUC model 2: 0.877, P=0.047). In model 2, significant predictors of stage shift growth included initial nodule size [odds ratio (OR) =4.074, 95% CI: 1.368-12.135; P=0.012], SSN classification (OR =0.042; 95% CI: 0.006-0.288; P=0.001), follow-up period (OR =1.692, 95% CI: 1.337-2.140; P<0.001), and VDT classification (OR =2.327, 95% CI: 1.368-3.958; P=0.002). For the stage shift, the mean progression time for the VDT (>400 d) group was 7.595 years, and median progression time was 7.430 years. Additionally, a VDT ≤400 d is an important prognostic factor associated with aggressive growth behavior with a stage shift.
CONCLUSIONS
VDT is crucial for predicting SSN stage shift growth irrespective of clinical and CT semantic features. This highlights its significance in informing follow-up protocols and surgical planning, emphasizing its prognostic value in predicting SSN growth.
PubMed: 38846271
DOI: 10.21037/qims-23-1759 -
Frontiers in Oncology 2024The detection rate of ground glass nodules (GGNs) has increased in recent years because of their malignant potential but relatively indolent biological behavior; thus,... (Review)
Review
The detection rate of ground glass nodules (GGNs) has increased in recent years because of their malignant potential but relatively indolent biological behavior; thus, correct GGN recognition and management has become a research focus. Many scholars have explored the underlying mechanism of the indolent progression of GGNs from several perspectives, such as pathological type, genomic mutational characteristics, and immune microenvironment. GGNs have different major mutated genes at different stages of development; mutation is the most common mutation in GGNs, and mutation is the most abundant mutation in the invasive stage of GGNs. Pure GGNs have fewer genomic alterations and a simpler genomic profile and exhibit a gradually evolving genomic mutation profile as the pathology progresses. Compared to advanced lung adenocarcinoma, GGN lung adenocarcinoma has a higher immune cell percentage, is under immune surveillance, and has less immune escape. However, as the pathological progression and solid component increase, negative immune regulation and immune escape increase gradually, and a suppressive immune environment is established gradually. Currently, regular computer tomography monitoring and surgery are the main treatment strategies for persistent GGNs. Stereotactic body radiotherapy and radiofrequency ablation are two local therapeutic alternatives, and systemic therapy has been progressively studied for lung cancer with GGNs. In the present review, we discuss the characterization of the multidimensional molecular evolution of GGNs that could facilitate more precise differentiation of such highly heterogeneous lesions, laying a foundation for the development of more effective individualized treatment plans.
PubMed: 38841161
DOI: 10.3389/fonc.2024.1380527 -
Cureus May 2024Dermatofibrosarcoma protuberans (DFSP) is a low- to intermediate-grade dermal soft tissue malignant tumor (sarcoma) with a high local recurrence rate but low metastatic...
Dermatofibrosarcoma protuberans (DFSP) is a low- to intermediate-grade dermal soft tissue malignant tumor (sarcoma) with a high local recurrence rate but low metastatic potential. DFSP is characterized by uniform spindle cell fascicles arranged classically in a storiform pattern and by CD34 immunoreactivity. On gross examination, DFSP usually manifests as a white or yellow soft tissue mass with a smooth outer surface and poor circumscription. In this study, we report a case of DFSP with fibrosarcomatous transformation, a rare but well-known phenomenon encountered in DFSP that is correlated with an increased risk of adverse outcomes in patients with DFSP. A 45-year-old male presented with a progressively enlarging lump on his left shoulder, initially suspected of being a lipoma but diagnosed as a fibrosarcomatous transformation of DFSP. Surgical resection was performed, with the subsequent identification of metastatic sarcoma in pulmonary nodules. Robotic-assisted thoracoscopy excised the nodules, confirming metastatic sarcoma with aggressive behavior. Despite negative adjuvant treatment plans, the patient remains under surveillance with imaging, showing no recurrence in recent scans. Continued follow-up with medical and surgical oncology is planned. DFSP is a rare soft tissue sarcoma characterized by indolent growth and low metastatic potential, except in fibrosarcomatous transformation cases. Molecularly, DFSP is defined by a COL1A1-PDGFB fusion transcript that is targetable with imatinib therapy. Treatment involves wide surgical resection, with adjuvant radiation therapy in select cases. Radiation therapy may be employed in cases with close or positive margins, while conventional chemotherapy has limited utility. Multidisciplinary collaboration is crucial for optimal management. Overall, this case underscores the challenges in diagnosing and managing aggressive sarcomas like fibrosarcomatous DFSP, emphasizing the importance of vigilant surveillance and multidisciplinary collaboration in optimizing patient outcomes. Further research is needed to understand the mechanisms underlying fibrosarcomatous transformation and to explore novel therapeutic avenues for this challenging malignancy.
PubMed: 38841035
DOI: 10.7759/cureus.59742 -
Cureus May 2024Granulomatosis with polyangiitis (GPA), previously referred to as Wegener's granulomatosis, is an uncommon form of necrotizing vasculitis that predominantly targets...
Granulomatosis with polyangiitis (GPA), previously referred to as Wegener's granulomatosis, is an uncommon form of necrotizing vasculitis that predominantly targets small and medium-sized blood vessels as a result of granulomatous inflammation. Granulomatosis with polyangiitis is defined by the existence of necrotizing granulomas in the upper respiratory tract, along with renal involvement, which includes necrotizing glomerulonephritis with extra capillary crescents. From a diagnostic perspective, there is a high correlation between GPA and proteinase-3 anti-neutrophil cytoplasmic antibody (PR3-ANCA) because of the release of inflammatory cytokines, reactive oxygen species (ROS), and lytic enzymes. While ANCA-positive serology is commonly used as the diagnostic criteria, we present a seronegative GPA case with isolated lung lesions. A 54-year-old woman was referred for an assessment of hemoptysis and alterations in her chest radiograph. The patient's laboratory results showed a positive QuantiFERON test but negative results for ANCA and antinuclear antibodies (ANA) tests. A chest CT scan showed the presence of several pulmonary nodules in both lungs, with some cavitation. A CT-guided biopsy was conducted on a nodule located in the lower lobe of the right lung. The results showed that the nodule had non-neoplastic chronic inflammation and an area of geographic necrosis. A second robotic-assisted left upper and lower lobe wedge resection was done, which showed white to tan granular lesions with necrotizing granulomatous inflammation and lymph nodes with anthracosis and a lot of histiocytes, which is typical of GPA. The patient received a six-month course of intravenous rituximab treatment.
PubMed: 38841015
DOI: 10.7759/cureus.59692 -
Alternative Therapies in Health and... Jun 2024To compare the positioning effect of three-dimensional reconstruction technology and Hook-wire puncture operation on small pulmonary nodules during video-assisted...
OBJECTIVE
To compare the positioning effect of three-dimensional reconstruction technology and Hook-wire puncture operation on small pulmonary nodules during video-assisted thoracoscopic surgery (VATS), and evaluate its effectiveness, efficiency, and safety.
METHODS
The subjects of this study were 50 patients with small pulmonary nodules admitted to the Department of Cardiothoracic Surgery of Heilongjiang Provincial Hospital from January 2020 to December 2022, and all underwent thoracoscopic surgical resection. All study subjects met the inclusion criteria, grouping according to the intraoperative positioning method, the control group (n = 25) used Hook-wire puncture positioning, and the observation group (n = 25) used three-dimensional reconstruction technology. The positioning effect, pain level, and postoperative complications were compared between the two groups.
RESULTS
The incidence rate of complications after puncture was 16.00% in the control group and 4.00% in the observation group, the complication rate in the observation group was significantly lower; the positioning success rate of the observation group was 96.00%, which was higher than that of the control group (92.00%). The operation time (32.25±6.08) min was lower than (38.50±7.12) min in the control group. The two groups had no statistical significance in the wedge resection success rate, VAS score, and complication rate (P > .05).
CONCLUSION
Three-dimensional reconstruction technology mainly makes preliminary judgments on the location, shape, size, and relationship between nodules and surrounding tissues based on preoperative CT scan images. It can select suitable scanning locations, map puncture paths, and anchor them in and around small lung nodules. The operation is simple, and the positioning success rate is high. The existence of three-dimensional reconstruction technology to position the guide wire can quickly shorten the time to detect lesions, shorten the time of VATS, reduce the occurrence of pulmonary infection in patients, and improve the prognosis.
PubMed: 38836733
DOI: No ID Found