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European Radiology Mar 2023To provide an overarching evaluation of the value of peritumoral CT radiomics features for predicting the prognosis of non-small cell lung cancer and to assess the...
OBJECTIVES
To provide an overarching evaluation of the value of peritumoral CT radiomics features for predicting the prognosis of non-small cell lung cancer and to assess the quality of the available studies.
METHODS
The PubMed, Embase, Web of Science, and Cochrane Library databases were searched for studies predicting the prognosis in patients with non-small cell lung cancer (NSCLC) using CT-based peritumoral radiomics features. Information about the patient, CT-scanner, and radiomics analyses were all extracted for the included studies. Study quality was assessed using the Radiomics Quality Score (RQS) and the Prediction Model Risk of Bias Assessment Tool (PROBAST).
RESULTS
Thirteen studies were included with 2942 patients from 2017 to 2022. Only one study was prospective, and the others were all retrospectively designed. Manual segmentation and multicenter studies were performed by 69% and 46% of the included studies, respectively. 3D-Slicer and MATLAB software were most commonly used for the segmentation of lesions and extraction of features. The peritumoral region was most frequently defined as dilated from the tumor boundary of 15 mm, 20 mm, or 30 mm. The median RQS of the studies was 13 (range 4-19), while all of included studies were assessed as having a high risk of bias (ROB) overall.
CONCLUSIONS
Peritumoral radiomics features based on CT images showed promise in predicting the prognosis of NSCLC, although well-designed studies and further biological validation are still needed.
KEY POINTS
• Peritumoral radiomics features based on CT images are promising and encouraging for predicting the prognosis of non-small cell lung cancer. • The peritumoral region was often dilated from the tumor boundary of 15 mm or 20 mm because these were considered safe margins. • The median Radiomics Quality Score of the included studies was 13 (range 4-19), and all of studies were considered to have a high risk of bias overall.
Topics: Humans; Carcinoma, Non-Small-Cell Lung; Lung Neoplasms; Retrospective Studies; Prospective Studies; Tomography, X-Ray Computed; Prognosis
PubMed: 36307554
DOI: 10.1007/s00330-022-09174-8 -
Life (Basel, Switzerland) Oct 2022Dirofilariasis is a zoonosis caused by nematodes of the genus is cosmopolitan as regards its distribution in animals, being responsible for human pulmonary...
Dirofilariasis is a zoonosis caused by nematodes of the genus is cosmopolitan as regards its distribution in animals, being responsible for human pulmonary dirofilariasis in the New World. However, human infections by are exceptional in Europe, and the previously reported Italian cases of pulmonary dirofilariasis were due to . We performed a systematic literature review of the Italian cases of human dirofilariasis due to according to the PRISMA guidelines. We also report the first autochthonous case of human pulmonary dirofilariasis due to , confirmed by polymerase chain reaction analysis. The patient was a 60-year-old man who lived in the Po river valley and had never traveled abroad; on histological examination, the 2-cm nodule found in his right upper lung was an infarct due to a parasitic thrombotic lesion. Only one other autochthonous (but conjunctival) case due to (molecularly confirmed) was previously found in the same geographic area. Climatic changes, the increasing movements of animal reservoirs and vectors, and new competent carriers have expanded the geographic distribution of the species, increasing the risk of human infections. Our report demonstrates that at least some pulmonary Italian cases of human dirofilariasis are due to , as in the New World.
PubMed: 36295019
DOI: 10.3390/life12101584 -
Wideochirurgia I Inne Techniki... Sep 2022Both coil and hook-wire localization techniques are commonly employed prior to video-assisted thoracic surgery (VATS) resection in patients with lung nodules (LNs), but... (Review)
Review
INTRODUCTION
Both coil and hook-wire localization techniques are commonly employed prior to video-assisted thoracic surgery (VATS) resection in patients with lung nodules (LNs), but the relative advantages of each remain uncertain.
AIM
This meta-analysis was performed to explore the relative safety and efficacy of coil localization (CL) and hook-wire localization (HWL) for patients with LNs.
MATERIAL AND METHODS
The PubMed, Embase, Cochrane Library, Wanfang, and CINK databases were searched to identify relevant studies published as of February 2022, after which pooled analyses of study outcomes were conducted.
RESULTS
In total, 8 studies met the inclusion criteria for the present meta-analysis. Successful localization rates were higher for the CL group relative to the HWL group (p = 0.0001). The CL group additionally exhibited significantly lower pooled total complication, pneumothorax, and lung hemorrhage rates relative to the HWL group (p = 0.01, p = 0.0001, p = 0.0009). Pooled duration of localization, VATS procedure duration, and wedge resection duration values were comparable in both groups (p = 0.69, p = 0.16, p = 0.76), as were chest pain scores (p = 0.06). When specifically analyzing the subset of patients with ground-glass LNs, pooled pneumothorax rates were significantly lower in the CL group relative to the HWL group (p = 0.03). Significant publication bias was detected with respect to rates of lung hemorrhage (Egger test, p = 0.029), but was not evident for other analyzed variables.
CONCLUSIONS
These results suggest that the coil-based localization of LNs before VATS resection is safer and more effective than hook-wire localization.
PubMed: 36187068
DOI: 10.5114/wiitm.2022.116396 -
European Radiology Mar 2023To calculate the pooled incidence of interval growth after long-term follow-up and identify predictors of interval growth in subsolid nodules (SSNs) on chest CT. (Meta-Analysis)
Meta-Analysis
OBJECTIVES
To calculate the pooled incidence of interval growth after long-term follow-up and identify predictors of interval growth in subsolid nodules (SSNs) on chest CT.
METHODS
A search of MEDLINE (PubMed), Cochrane Library, Web of Science Core Collection, and Embase was performed on November 08, 2021, for relevant studies. Patient information, CT scanner, and SSN follow-up information were extracted from each included study. A random-effects model was applied along with subgroup and meta-regression analyses. Study quality was assessed by the Newcastle-Ottawa scale, and publication bias was assessed by Egger's test.
RESULTS
Of the 6802 retrieved articles, 16 articles were included and analyzed, providing a total of 2898 available SSNs. The pooled incidence of growth in the 2898 SSNs was 22% (95% confidence interval [CI], 15-29%). The pooled incidence of growth in the subgroup analysis of pure ground-glass nodules was 26% (95% CI: 12-39%). The incidence of SSN growth after 2 or more years of stability was only 5% (95% CI: 3-7%). An initially large SSN size was found to be the most frequent risk factor affecting the incidence of SSN growth and the time of growth.
CONCLUSIONS
The pooled incidence of SSN growth was as high as 22%, with a 26% incidence reported for pure ground-glass nodules. Although the incidence of growth was only 5% after 2 or more years of stability, long-term follow-up is needed in certain cases. Moreover, the initial size of the SSN was the most frequent risk factor for growth.
KEY POINTS
• Based on a meta-analysis of 2898 available subsolid nodules in the literature, the pooled incidence of growth was 22% for all subsolid nodules and 26% for pure ground-glass nodules. • After 2 or more years of stability on follow-up CT, the pooled incidence of subsolid nodule growth was only 5%. • Given the incidence of subsolid nodule growth, management of these lesions with long-term follow-up is preferred.
Topics: Humans; Lung Neoplasms; Tomography, X-Ray Computed; Tomography Scanners, X-Ray Computed; Risk Factors
PubMed: 36136107
DOI: 10.1007/s00330-022-09138-y -
Translational Cancer Research Aug 2022This study aimed to systematically evaluate and compare the diagnostic value of bubble lucency, interface, lobulated margin and spiculation in distinguishing early...
Diagnostic value of double low-dose targeted perfusion CT imaging for the diagnosis of invasive and preinvasive pulmonary ground-glass nodules: systematic review and meta-analysis.
BACKGROUND
This study aimed to systematically evaluate and compare the diagnostic value of bubble lucency, interface, lobulated margin and spiculation in distinguishing early invasive and preinvasive intrapulmonary ground-glass nodules (GGNs) using evidence-based meta-analysis methods. Dual low-dose targeted perfusion computed tomography (CT) imaging is controversial in the diagnosis of invasive and preinvasive ground-glass nodules. Different studies have different views and opinions. Therefore, it is necessary to conduct a systematic review of this subject in the form of meta-analysis to guide clinical diagnosis and treatment.
METHODS
PubMed, Web of Science, Cochrane library and Embase were searched for recent documentation on the diagnostic value of different signs in invasive and preinvasive pulmonary GGNs. CT imaging signs of bubble lucency, speculation, interface, lobulated margin, and spiculation were used as diagnostic references to discriminate pre-invasive and invasive disease. The sensitivity, specificity, summary receiver operating characteristic (SROC) curves, and the area under the SROC curve (AUC) were calculated to evaluate diagnostic efficiency.
RESULTS
The diagnostic sensitivity and specificity using bubble lucency as a reference of invasive ground-glass opacity (GGO) discrimination was 0.33 (0.24-0.44) and 0.74 (0.62-0.83) respectively. For interface, lobulated margin, and speculation, the diagnostic sensitivity were 0.30 (0.21-0.41), 0.49 (0.39-0.60) and 0.22 (0.14-0.33); and the specificity were 0.83 (0.74-0.89), 0.66 (0.49-0.80) and 0.86 (0.67-0.95). The pooled ROC curve was drawn by sensitivity against 1-specificity using Stata version 15.0. The area under the ROC curve (AUC) values were 0.53, 0.60, 0.58, and 0.43 for bubble lucency, speculation, lobulated margin, and pleural indentation of GGO for discriminating pre-invasive and invasive disease.
CONCLUSIONS
The diagnostic value of a single CT imaging sign of GGO, such as bubble lucency, speculation, interface, lobulated margin, and spiculation is limited for discriminating pre-invasive and invasive disease because of low sensitivity, specificity, and AUC.
PubMed: 36093551
DOI: 10.21037/tcr-22-790 -
Pediatric Rheumatology Online Journal Aug 2022Antineutrophil cytoplasmic antibody (ANCA)-associated vasculitis (AAV) is a rare form of vasculitis in children. SARS-CoV-2, the virus that causes COVID-19 infection,...
BACKGROUND
Antineutrophil cytoplasmic antibody (ANCA)-associated vasculitis (AAV) is a rare form of vasculitis in children. SARS-CoV-2, the virus that causes COVID-19 infection, seems to trigger autoimmunity and new-onset autoimmune disease in pediatric and adult patients. We present a case of new-onset AAV following COVID-19 infection in an adolescent patient, and we review the literature of AAV following COVID-19 infection.
CASE PRESENTATION
An adolescent female with a history of asthma was diagnosed with mild COVID-19 infection and subsequently developed persistent cough, wheezing, hearing loss, arthralgias, and rash. Her imaging and laboratory workup showed pulmonary nodules and cavitary lesions, elevated inflammatory markers, negative infectious testing, and positive ANCA. She was treated with glucocorticoids, rituximab, and mycophenolate mofetil. At six-month follow-up, she had improvement in her symptoms, pulmonary function tests, imaging findings, and laboratory markers.
CONCLUSIONS
We report the second case of new-onset anti-PR3, C-ANCA vasculitis and the fourth case of pediatric-onset AAV following COVID-19 infection. A systematic review of the literature found 6 cases of new-onset AAV in adults after COVID-19 infection. Pediatric and adult patients who develop AAV post COVID-19 infection have few, if any, comorbidities, and show marked radiographic and symptomatic improvement after treatment. There is increasing evidence for COVID-19-induced autoimmunity in children and our case highlights the importance of considering AAV in a child following a recent COVID-19 infection because timely treatment may improve clinical outcomes.
Topics: Adolescent; Adult; Anti-Neutrophil Cytoplasmic Antibody-Associated Vasculitis; Antibodies, Antineutrophil Cytoplasmic; COVID-19; Child; Exanthema; Female; Humans; SARS-CoV-2
PubMed: 35964067
DOI: 10.1186/s12969-022-00727-1 -
Frontiers in Surgery 2022Video-Assisted and Robotic-Assisted techniques become constantly more prominent practice in thoracic surgery for lung cancer. Furthermore, the increased frequency in... (Review)
Review
BACKGROUND
Video-Assisted and Robotic-Assisted techniques become constantly more prominent practice in thoracic surgery for lung cancer. Furthermore, the increased frequency in detection of small lung cancers makes the intra-operative identification of these cancers even more challenging. Indocyanine Green (ICG) is one of the most commonly used dyes that assists surgeons identify small lung cancers intra-operatively. Our study aimed to evaluate the effectiveness and safety of ICG in lung cancer detection.
METHODS
We performed a systematic review of the literature by screening the databases of MEDLINE, EMBASE, CENTRAL and Scopus until 30th April 2022 and the first 300 articles of Google Scholar for any suitable grey literature. We included any study that investigated the effectiveness of ICG in lung cancer detection. We excluded studies that explored the use of ICG only in identification of intersegmental planes, lymph node mapping, case reports and non-English articles. We aimed to perform a meta-analysis on test accuracy studies using hierarchical summary receiver operating characteristic (HSROC) and the bivariate random-effects models. In cases where the data for a localization technique was not sufficient for that analysis, it was presented with tables with narrative purposes. Each study was assessed for Risk of Bias (RoB) and Applicability using the QUADAS-2 tool.
RESULTS
We found 30 eligible studies that included a total of 1,776 patients who underwent ICG localization of pulmonary nodules. We identified three ICG localization techniques: CT-guided, endobronchial and intravenous. From the 30 studies, 13 investigated CT-guided localization, 12 explored an endobronchial method while 8 studies administered ICG intravenously the median reported success rate was 94.3% (IQR: 91.4%-100%) and 98.3% (IQR: 94%-100%) for the first two techniques respectively. Intravenous ICG lung cancer localization showed Sensitivity of 88% (95% CI: 59%-0.97%) and Specificity of 25% (95% CI: 0.04%-0.74%). There were 15.2% (150/989) patients who experienced complications from CT guided ICG localization. No ICG-related complications were reported in endobronchial or intravenous techniques.
CONCLUSION
Our study provides a comprehensive review of the literature on ICG localization techniques for lung cancer. Current evidence suggests that ICG is boh effective and safe. Further prospective research with standardized protocols across multiple thoracic units is required in order to accurately validate these findings.
PubMed: 35959126
DOI: 10.3389/fsurg.2022.967897 -
Frontiers in Public Health 2022Artificial intelligence has far surpassed previous related technologies in image recognition and is increasingly used in medical image analysis. We aimed to explore the... (Meta-Analysis)
Meta-Analysis
BACKGROUND
Artificial intelligence has far surpassed previous related technologies in image recognition and is increasingly used in medical image analysis. We aimed to explore the diagnostic accuracy of the models based on deep learning or radiomics for lung cancer staging.
METHODS
Studies were systematically reviewed using literature searches from PubMed, EMBASE, Web of Science, and Wanfang Database, according to PRISMA guidelines. Studies about the diagnostic accuracy of radiomics and deep learning, including the identifications of lung cancer, tumor types, malignant lung nodules and lymph node metastase, were included. After identifying the articles, the methodological quality was assessed using the QUADAS-2 checklist. We extracted the characteristic of each study; the sensitivity, specificity, and AUROC for lung cancer diagnosis were summarized for subgroup analysis.
RESULTS
The systematic review identified 19 eligible studies, of which 14 used radiomics models and 5 used deep learning models. The pooled AUROC of 7 studies to determine whether patients had lung cancer was 0.83 (95% CI 0.78-0.88). The pooled AUROC of 9 studies to determine whether patients had NSCLC was 0.78 (95% CI 0.73-0.83). The pooled AUROC of the 6 studies that determined patients had malignant lung nodules was 0.79 (95% CI 0.77-0.82). The pooled AUROC of the other 6 studies that determined whether patients had lymph node metastases was 0.74 (95% CI 0.66-0.82).
CONCLUSION
The models based on deep learning or radiomics have the potential to improve diagnostic accuracy for lung cancer staging.
SYSTEMATIC REVIEW REGISTRATION
https://inplasy.com/inplasy-2022-3-0167/, identifier: INPLASY202230167.
Topics: Artificial Intelligence; Deep Learning; Humans; Lung; Lung Neoplasms; Neoplasm Staging
PubMed: 35923964
DOI: 10.3389/fpubh.2022.938113 -
The Cochrane Database of Systematic... Aug 2022Lung cancer is the most common cause of cancer-related death in the world, however lung cancer screening has not been implemented in most countries at a population... (Meta-Analysis)
Meta-Analysis Review
BACKGROUND
Lung cancer is the most common cause of cancer-related death in the world, however lung cancer screening has not been implemented in most countries at a population level. A previous Cochrane Review found limited evidence for the effectiveness of lung cancer screening with chest radiography (CXR) or sputum cytology in reducing lung cancer-related mortality, however there has been increasing evidence supporting screening with low-dose computed tomography (LDCT). OBJECTIVES: To determine whether screening for lung cancer using LDCT of the chest reduces lung cancer-related mortality and to evaluate the possible harms of LDCT screening.
SEARCH METHODS
We performed the search in collaboration with the Information Specialist of the Cochrane Lung Cancer Group and included the Cochrane Lung Cancer Group Trial Register, Cochrane Central Register of Controlled Trials (CENTRAL, the Cochrane Library, current issue), MEDLINE (accessed via PubMed) and Embase in our search. We also searched the clinical trial registries to identify unpublished and ongoing trials. We did not impose any restriction on language of publication. The search was performed up to 31 July 2021. SELECTION CRITERIA: Randomised controlled trials (RCTs) of lung cancer screening using LDCT and reporting mortality or harm outcomes. DATA COLLECTION AND ANALYSIS: Two review authors were involved in independently assessing trials for eligibility, extraction of trial data and characteristics, and assessing risk of bias of the included trials using the Cochrane RoB 1 tool. We assessed the certainty of evidence using GRADE. Primary outcomes were lung cancer-related mortality and harms of screening. We performed a meta-analysis, where appropriate, for all outcomes using a random-effects model. We only included trials in the analysis of mortality outcomes if they had at least 5 years of follow-up. We reported risk ratios (RRs) and hazard ratios (HRs), with 95% confidence intervals (CIs) and used the I statistic to investigate heterogeneity. MAIN RESULTS: We included 11 trials in this review with a total of 94,445 participants. Trials were conducted in Europe and the USA in people aged 40 years or older, with most trials having an entry requirement of ≥ 20 pack-year smoking history (e.g. 1 pack of cigarettes/day for 20 years or 2 packs/day for 10 years etc.). One trial included male participants only. Eight trials were phase three RCTs, with two feasibility RCTs and one pilot RCT. Seven of the included trials had no screening as a comparison, and four trials had CXR screening as a comparator. Screening frequency included annual, biennial and incrementing intervals. The duration of screening ranged from 1 year to 10 years. Mortality follow-up was from 5 years to approximately 12 years. None of the included trials were at low risk of bias across all domains. The certainty of evidence was moderate to low across different outcomes, as assessed by GRADE. In the meta-analysis of trials assessing lung cancer-related mortality, we included eight trials (91,122 participants), and there was a reduction in mortality of 21% with LDCT screening compared to control groups of no screening or CXR screening (RR 0.79, 95% CI 0.72 to 0.87; 8 trials, 91,122 participants; moderate-certainty evidence). There were probably no differences in subgroups for analyses by control type, sex, geographical region, and nodule management algorithm. Females appeared to have a larger lung cancer-related mortality benefit compared to males with LDCT screening. There was also a reduction in all-cause mortality (including lung cancer-related) of 5% (RR 0.95, 95% CI 0.91 to 0.99; 8 trials, 91,107 participants; moderate-certainty evidence). Invasive tests occurred more frequently in the LDCT group (RR 2.60, 95% CI 2.41 to 2.80; 3 trials, 60,003 participants; moderate-certainty evidence). However, analysis of 60-day postoperative mortality was not significant between groups (RR 0.68, 95% CI 0.24 to 1.94; 2 trials, 409 participants; moderate-certainty evidence). False-positive results and recall rates were higher with LDCT screening compared to screening with CXR, however there was low-certainty evidence in the meta-analyses due to heterogeneity and risk of bias concerns. Estimated overdiagnosis with LDCT screening was 18%, however the 95% CI was 0 to 36% (risk difference (RD) 0.18, 95% CI -0.00 to 0.36; 5 trials, 28,656 participants; low-certainty evidence). Four trials compared different aspects of health-related quality of life (HRQoL) using various measures. Anxiety was pooled from three trials, with participants in LDCT screening reporting lower anxiety scores than in the control group (standardised mean difference (SMD) -0.43, 95% CI -0.59 to -0.27; 3 trials, 8153 participants; low-certainty evidence). There were insufficient data to comment on the impact of LDCT screening on smoking behaviour. AUTHORS' CONCLUSIONS: The current evidence supports a reduction in lung cancer-related mortality with the use of LDCT for lung cancer screening in high-risk populations (those over the age of 40 with a significant smoking exposure). However, there are limited data on harms and further trials are required to determine participant selection and optimal frequency and duration of screening, with potential for significant overdiagnosis of lung cancer. Trials are ongoing for lung cancer screening in non-smokers.
Topics: Adult; Bias; Early Detection of Cancer; Female; Humans; Lung Neoplasms; Male; Randomized Controlled Trials as Topic; Tomography, X-Ray Computed
PubMed: 35921047
DOI: 10.1002/14651858.CD013829.pub2 -
Clinical Imaging Oct 2022Common CT abnormalities of pulmonary aspergillosis represent a cavity with air-meniscus sign, nodule, mass, and consolidation having an angio-invasive pattern. This...
PURPOSE
Common CT abnormalities of pulmonary aspergillosis represent a cavity with air-meniscus sign, nodule, mass, and consolidation having an angio-invasive pattern. This study aims to conduct a systematic review and an individual patient-level image analysis of CT findings of COVID-19-associated pulmonary aspergillosis (CAPA).
METHODS
A systematic literature search was conducted to identify studies reporting CT findings of CAPA as of January 7, 2021. We summarized study-level clinical and CT findings of CAPA and collected individual patient CT images by inviting corresponding authors. The CT findings were categorized into four groups: group 1, typical appearance of COVID-19; group 2, indeterminate appearance of COVID-19; group 3, atypical for COVID-19 without cavities; and group 4, atypical for COVID-19 with cavities. In group 2, cases had only minor discrepant findings including solid nodules, isolated airspace consolidation with negligible ground-glass opacities, centrilobular micronodules, bronchial abnormalities, and cavities.
RESULTS
The literature search identified 89 patients from 25 studies, and we collected CT images from 35 CAPA patients (mean age 62.4 ± 14.6 years; 21 men): group 1, thirteen patients (37.1%); group 2, eight patients (22.9%); group 3, six patients (17.1%); and group 4, eight patients (22.9%). Eight of the 14 patients (57.1%) with an atypical appearance had bronchial abnormalities, whereas only one (7.1%) had an angio-invasive fungal pattern. In the study-level analysis, cavities were reported in 12 of 54 patients (22.2%).
CONCLUSION
CAPA can frequently manifest as COVID-19 pneumonia without common CT abnormalities of pulmonary aspergillosis. If abnormalities exist on CT images, CAPA may frequently accompany bronchial abnormalities.
Topics: Aged; COVID-19; Data Analysis; Humans; Lung; Male; Middle Aged; Pulmonary Aspergillosis; Tomography, X-Ray Computed
PubMed: 35908455
DOI: 10.1016/j.clinimag.2022.07.003