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Polish Journal of Radiology 2017A systematic review and meta-analysis of all available publications was performed to evaluate the diagnostic accuracy of percutaneous transthoracic needle biopsy (PTNB)...
BACKGROUND
A systematic review and meta-analysis of all available publications was performed to evaluate the diagnostic accuracy of percutaneous transthoracic needle biopsy (PTNB) using a C-Arm Cone-Beam CT (CBCT) system in patients with lung nodules.
MATERIAL/METHODS
Thedatabases of PUBMED, OVID, EBSCO, EMBASE, and China National Knowledge Infrastructure (CNKI) were systematically searched for relevant original articles on the diagnostic accuracy of CBCT-guided PTNB for the diagnosis of nodules in the lungs. Diagnostic indices including sensitivity, specificity, positive likelihood ratio (PLR), negative likelihood ratio (NLR), diagnostic odds ratio (DOR) and diagnostic score (DS) were calculated. Moreover,summary receiver operating characteristic curves (SROC) were constructed with Stata (version 13.0), Rev Man (version 5.3), and Meta-disc (version 1.4) software. Other clinical indices such as incidence of complications were also recorded.
RESULTS
Eight studies met the inclusion and exclusion criteria for the meta-analysis. The pooled sensitivity, specificity, PLR, NLR, DOR, DS, and SROC with 95% confidence intervals were 0.96 (0.93-0.98), 1.00 (0.91-1.00), 711.15 (9.48-53325.89), 0.04 (0.02-0.07), 16585.29 (284.88-9.7e+05), 9.72 (5.65-13.78), and 0.99 (0.97-0.99), respectively. The incidence of pneumothorax and hemorrhage was 10-29.27% and 1.22-47.25%, respectively.
CONCLUSIONS
CBCT-guided PTNB has an acceptable rate of complications and is associated with a reasonable radiation exposure. Moreover, it is a highly accurate and safe technique for the diagnosis of lung nodules and can be recommended to be used in routine clinical practice.
PubMed: 28392852
DOI: 10.12659/PJR.899626 -
Medicine Jan 2017Organizing pneumonia (OP) is a clinicopathological entity characterized by granulation tissue plugs in the lumen of small airways, alveolar ducts, and alveoli. OP can be... (Review)
Review
RATIONALE
Organizing pneumonia (OP) is a clinicopathological entity characterized by granulation tissue plugs in the lumen of small airways, alveolar ducts, and alveoli. OP can be cryptogenic (primary) (COP) or secondary to various lung injuries.
PATIENT CONCERNS
We report the case of a 38-year-old male smoker with COP presenting in the form of diffuse micronodules on computed tomography (CT) scan and describe the clinical, radiological, and functional characteristics of micronodular pattern of organizing pneumonia (MNOP) based on a review of the literature including 14 cases.Patients were younger (36.3 ± 15.5 years) than those with the classical form of OP. The clinical presentation was subacute in all cases with a mean duration of symptoms before admission of 14.5 ± 13.2 days. The radiological pattern was characterized by centrilobular nodules and "bud-in-tree" sign in 86.7% of patients. The diagnosis was based on histological examination of transbronchial (28.6%) or surgical biopsies (71.4%).
DIAGNOSIS
An associated condition was identified in 65% of cases and included illicit substance abuse (44.5%), myeloproliferative disease (33.5%), and infections (22%).
OUTCOMES
Steroid therapy was effective in all patients with improvement of symptoms and documented radiologic resolution. No relapse was recorded.
LESSONS
MNOP should be recognized and distinguished from other diagnoses, mainly infectious bronchiolitis and disseminated tumor, as it requires early specific steroid therapy.
Topics: Adult; Cryptogenic Organizing Pneumonia; Humans; Lung; Male
PubMed: 28099335
DOI: 10.1097/MD.0000000000005788 -
The British Journal of Radiology Dec 2016To compare the diagnostic accuracy of digital tomosynthesis (DTS) with that of chest radiography for the detection of pulmonary nodules by meta-analysis. (Meta-Analysis)
Meta-Analysis Review
OBJECTIVE
To compare the diagnostic accuracy of digital tomosynthesis (DTS) with that of chest radiography for the detection of pulmonary nodules by meta-analysis.
METHODS
A systematic literature search was performed to identify relevant original studies from 1 January 1 1976 to 31 August 31 2016. The quality of included studies was assessed by quality assessment of diagnostic accuracy studies-2. Per-patient data were used to calculate the sensitivity and specificity and per-lesion data were used to calculate the detection rate. Summary receiver-operating characteristic curves were drawn for pulmonary nodule detection.
RESULTS
16 studies met the inclusion criteria. 1017 patients on a per-patient basis and 2159 lesions on a per-lesion basis from 16 eligible studies were evaluated. The pooled patient-based sensitivity of DTS was 0.85 [95% confidence interval (CI) 0.83-0.88] and the specificity was 0.95 (0.93-0.96). The pooled sensitivity and specificity of chest radiography were 0.47 (0.44-0.51) and 0.37 (0.34-0.40), respectively. The per-lesion detection rate was 2.90 (95% CI 2.63-3.19).
CONCLUSION
DTS has higher diagnostic accuracy than chest radiography for detection of pulmonary nodules. Chest radiography has low sensitivity but similar specificity, comparable with that of DTS. Advances in knowledge: DTS has higher diagnostic accuracy than chest radiography for the detection of pulmonary nodules.
Topics: Humans; Lung; Lung Neoplasms; Multiple Pulmonary Nodules; Radiography, Thoracic; Reproducibility of Results; Sensitivity and Specificity; Tomography, X-Ray Computed
PubMed: 27759428
DOI: 10.1259/bjr.20160421 -
PloS One 2016Tuberculosis is an important risk factor for chronic respiratory disease in resource poor settings. The persistence of abnormal spirometry and symptoms after treatment... (Review)
Review
BACKGROUND
Tuberculosis is an important risk factor for chronic respiratory disease in resource poor settings. The persistence of abnormal spirometry and symptoms after treatment are well described, but the structural abnormalities underlying these changes remain poorly defined, limiting our ability to phenotype post-TB lung disease in to meaningful categories for clinical management, prognostication, and ongoing research. The relationship between post-TB lung damage and patient-centred outcomes including functional impairment, respiratory symptoms, and health related quality of life also remains unclear.
METHODS
We performed a systematic literature review to determine the prevalence and pattern of imaging-defined lung pathology in adults after medical treatment for pleural, miliary, or pulmonary TB disease. Data were collected on study characteristics, and the modality, timing, and findings of thoracic imaging. The proportion of studies relating imaging findings to spirometry results and patient morbidity was recorded. Study quality was assessed using a modified Newcastle-Ottowa score. (Prospero Registration number CRD42015027958).
RESULTS
We identified 37 eligible studies. The principle features seen on CXR were cavitation (8.3-83.7%), bronchiectasis (4.3-11.2%), and fibrosis (25.0-70.4%), but prevalence was highly variable. CT imaging identified a wider range of residual abnormalities than CXR, including nodules (25.0-55.8%), consolidation (3.7-19.2%), and emphysema (15.0-45.0%). The prevalence of cavitation was generally lower (7.4-34.6%) and bronchiectasis higher (35.0-86.0%) on CT vs. CXR imaging. A paucity of prospective data, and data from HIV-infected adults and sub-Saharan Africa (sSA) was noted. Few studies related structural damage to physiological impairment, respiratory symptoms, or patient morbidity.
CONCLUSIONS
Post-TB structural lung pathology is common. Prospective data are required to determine the evolution of this lung damage and its associated morbidity over time. Further data are required from HIV-infected groups and those living in sSA.
Topics: Humans; Image Processing, Computer-Assisted; Pattern Recognition, Automated; Prevalence; Tomography, X-Ray Computed; Tuberculosis, Pulmonary; United Kingdom
PubMed: 27518438
DOI: 10.1371/journal.pone.0161176 -
Polskie Archiwum Medycyny Wewnetrznej Apr 2016The British Thoracic Society guideline on the investigation and management of pulmonary nodules is based on a comprehensive and systematic review of the literature on... (Review)
Review
The British Thoracic Society guideline on the investigation and management of pulmonary nodules is based on a comprehensive and systematic review of the literature on pulmonary nodules. Recent evidence has suggested that significant changes to existing guidelines are necessary. The use of 2 malignancy prediction calculators to better characterize the risk of malignancy was firmly supported by evidence, as were the recommendations for a higher nodule size threshold for follow‑up (≥5 mm or ≥80 mm3) and a reduction of the follow‑up period to 1 year for solid pulmonary nodules. Although caution is required where there is a history of cancer, both of these recommendations will reduce the number of follow‑up computed tomographies, thereby improving cost‑effectiveness and pressure on imaging services. Recent evidence has also confirmed the superiority of volumetry as the preferred measurement method and clarified the management of nodules with extended volume‑doubling times. Acknowledging the good prognosis of subsolid nodules, there are recommendations for less aggressive options in their management. The guidelines recommend ordinal scale reporting for positron emission tomography-computed tomography to facilitate incorporation into risk models. There are recommendations on when biopsy is most helpful, the threshold for treatment without histological confirmation, and surgical and nonsurgical treatment. The guideline also provides evidence‑based recommendations about the information that people need and that should be provided for them. The complexity of managing pulmonary nodules is made more accessible by 4 management algorithms. In the real world, it is surprising how easy these are to follow and how they seem to follow an intuitive approach.
Topics: Disease Management; Humans; Lung Neoplasms; Multiple Pulmonary Nodules; Societies, Medical; United Kingdom
PubMed: 27121867
DOI: 10.20452/pamw.3379 -
Computer Methods and Programs in... Feb 2016This work presents a systematic review of techniques for the 3D automatic detection of pulmonary nodules in computerized-tomography (CT) images. Its main goals are to... (Review)
Review
This work presents a systematic review of techniques for the 3D automatic detection of pulmonary nodules in computerized-tomography (CT) images. Its main goals are to analyze the latest technology being used for the development of computational diagnostic tools to assist in the acquisition, storage and, mainly, processing and analysis of the biomedical data. Also, this work identifies the progress made, so far, evaluates the challenges to be overcome and provides an analysis of future prospects. As far as the authors know, this is the first time that a review is devoted exclusively to automated 3D techniques for the detection of pulmonary nodules from lung CT images, which makes this work of noteworthy value. The research covered the published works in the Web of Science, PubMed, Science Direct and IEEEXplore up to December 2014. Each work found that referred to automated 3D segmentation of the lungs was individually analyzed to identify its objective, methodology and results. Based on the analysis of the selected works, several studies were seen to be useful for the construction of medical diagnostic aid tools. However, there are certain aspects that still require attention such as increasing algorithm sensitivity, reducing the number of false positives, improving and optimizing the algorithm detection of different kinds of nodules with different sizes and shapes and, finally, the ability to integrate with the Electronic Medical Record Systems and Picture Archiving and Communication Systems. Based on this analysis, we can say that further research is needed to develop current techniques and that new algorithms are needed to overcome the identified drawbacks.
Topics: Algorithms; Evidence-Based Medicine; Humans; Lung Neoplasms; Machine Learning; Pattern Recognition, Automated; Radiographic Image Enhancement; Radiographic Image Interpretation, Computer-Assisted; Reproducibility of Results; Sensitivity and Specificity; Software; Solitary Pulmonary Nodule; Tomography, X-Ray Computed
PubMed: 26652979
DOI: 10.1016/j.cmpb.2015.10.006 -
Respiration; International Review of... 2014Electromagnetic navigation bronchoscopy (ENB) is an emerging endoscopic technique for the diagnosis of peripheral lung lesions. A thorough analysis of ENB's yield and... (Meta-Analysis)
Meta-Analysis Review
BACKGROUND
Electromagnetic navigation bronchoscopy (ENB) is an emerging endoscopic technique for the diagnosis of peripheral lung lesions. A thorough analysis of ENB's yield and safety is required for comparison to other sampling modalities.
OBJECTIVES
To describe ENB's yield and safety profile.
METHODS
The MEDLINE and EMBASE databases were systematically searched for studies reporting ENB's yield for peripheral lung lesions. Two independent investigators extracted data and rated each study on a scale of methodological quality. Clearly defined performance outcomes were reconstructed and meta-analyzed. Subgroup analysis and meta-regression were used to identify possible sources of study heterogeneity.
RESULTS
A total of 15 trials were included (1,033 lung nodules). A positive and definitive diagnosis was obtained after 64.9% of all ENB procedures (95% CI 59.2-70.3). Overall diagnostic accuracy was 73.9% (95% CI 68.0-79.2). Sensitivity to detect cancer was 71.1% (95% CI 64.6-76.8), with a negative predictive value of 52.1% (95% CI 43.5-60.6). Pneumothorax occurred in 3.1% of patients, requiring chest tube drainage in 1.6% of these cases. Original trials identified 6 variables associated with higher ENB yields: nodule location in the upper or middle lobes, nodule size, lower registration error, presence of a bronchus sign on CT imaging, combined use of an ultrasonic radial probe, and catheter suctioning as a sampling technique. Heterogeneity exploration revealed that studies using general anesthesia or rapid on-site cytological evaluation reported better yields.
CONCLUSIONS
ENB is effective and particularly safe. Prospective studies are needed to clarify the role of several variables conditioning the yield of this technique.
Topics: Bronchoscopy; Humans; Solitary Pulmonary Nodule
PubMed: 24401166
DOI: 10.1159/000355710 -
World Journal of Surgical Oncology Jan 2014Metastases from breast cancer cause the frequent involvement of lung, bone, liver, and brain, while the occurrence of metastases to the gastrointestinal tract is rare,... (Review)
Review
BACKGROUND
Metastases from breast cancer cause the frequent involvement of lung, bone, liver, and brain, while the occurrence of metastases to the gastrointestinal tract is rare, and more frequently discovered after a primary diagnosis of breast cancer. Solitary pancreatic metastases from breast cancer, without widespread disease, are actually unusual, and only 19 cases have been previously described; truly exceptional is a solitary pancreatic metastasis becoming evident together with the primary breast cancer.
CASE PRESENTATION
A 68-year-old woman reported general fatigue, lethargy, and jaundice. Abdominal ultrasound (US) and magnetic resonance imaging (MRI) showed an ampulloma of Vater's papilla; moreover, a neoplastic nodule in the left breast was diagnosed. She underwent surgery for both breast cancer and ampulloma of Vater's papilla. Pathological examination of pancreatic specimen, however, did not confirm primary carcinoma of the duodenal papilla, but showed a metastatic involvement of pancreas from lobular breast cancer. Immunohistochemistry has been essential to confirm the origin of the malignancy: hormone receptors and mammaglobin were expressed in both the primary breast tumor and the pancreatic metastasis.
CONCLUSIONS
This is one of the few reported cases in literature of an isolated and synchronous pancreatic metastasis from breast cancer, where the definitive diagnosis was obtained only after surgery. We discuss the controversies in this diagnosis and the choice of correct treatment. The surgical resection of solitary metastases can be performed in the absence of disseminated disease.
Topics: Aged; Breast Neoplasms; Carcinoma, Lobular; Combined Modality Therapy; Female; Humans; Pancreatic Neoplasms; Prognosis
PubMed: 24387226
DOI: 10.1186/1477-7819-12-2 -
Annals of Oncology : Official Journal... Apr 2014Low-dose computed tomography (LDCT) screening has been shown to reduce mortality from lung cancer but at a substantial cost in diagnostic activity. The objective of this...
BACKGROUND
Low-dose computed tomography (LDCT) screening has been shown to reduce mortality from lung cancer but at a substantial cost in diagnostic activity. The objective of this study was to investigate the characteristics of screening programmes associated with recall rates, detection rates and positive predictive values (PPVs).
DESIGN
We conducted a systematic review of randomised trials and observational studies on LDCT screening for lung cancer. A meta-regression using random-effect logistic regressions was carried out to assess factors influencing recall rates for further investigation, cancer detection rates and PPVs of recall.
RESULTS
We used data from 63 372 prevalent screens from 16 studies of LDCT screening for lung cancer and 79 302 incident screens from nine studies. In univariable analysis, the use of a cut-off size to define nodules warranting further investigation at prevalent screens reduced recall rates [odds ratio (OR) = 0.44, 95% confidence interval (CI) 0.24-0.82 and OR = 0.42, 95% CI 0.21-0.84 for cut-off sizes of 3-4 and 5-8 mm, respectively], without significant changes in detection rates and PPVs. The number of readers (1 or ≥2) was not associated with changes in recall rates, detection rates and PPVs at prevalent and incident screens. Using the volumetry software at incident screens significantly increased the PPV (OR = 5.02, 95% CI 1.65-15.28) as a result of a decrease in recall rates (OR = 0.25, 95% CI 0.12-0.51), without significant changes in detection rates.
CONCLUSION
These results highlight the value of using a cut-off size for nodules warranting further investigation with lower recall rates at prevalent screens, whereas the volumetric assessment software at incident screens results in lower recall rates and higher PPVs. The presence of positron emission tomography in the work-up protocol might be associated with lower rates of surgical procedures for benign findings, although this hypothesis deserves further investigation.
Topics: Humans; Lung Neoplasms; Mass Screening; Randomized Controlled Trials as Topic; Tomography, X-Ray Computed
PubMed: 24297084
DOI: 10.1093/annonc/mdt491 -
Respiratory Medicine Jan 2014To describe the clinical characteristics of septic pulmonary embolism in adults in order to improve its diagnosis and treatment. (Review)
Review
OBJECTIVES
To describe the clinical characteristics of septic pulmonary embolism in adults in order to improve its diagnosis and treatment.
METHODS
Specific search terms were used for retrieval from commonly used Chinese and English databases and the articles were selected in accordance with the inclusion and exclusion criteria. Cases from the included articles were pooled; then the following parameters were analyzed: major risk factors, clinical manifestations, imaging findings, characteristics of pathogenic microorganisms, complications and other clinical characteristics.
RESULTS
After strictly selected by the inclusion and exclusion criteria, 76 articles were selected (2 Chinese articles and 74 English articles) that described 168 cases. The major risk factors for SPE were intravenous drug use (n = 44), intravascular indwelling catheter (n = 21) and skin or soft tissue purulent infection (n = 10). The most frequent clinical manifestations were fever (n = 144), dyspnea (n = 81), chest pain (n = 82) and cough (n = 69). Chest CT showed multiple peripheral nodules in both lungs (n = 89), cavitation (n = 75), focal or wedge-shaped infiltrates (n = 48) and pleural effusion (n = 40). Echocardiography often revealed vegetations (n = 52). Blood cultures grew methicillin-resistant Staphylococcus aureus (MRSA) (n = 27), methicillin-sensitive Staphylococcus aureus (MSSA) (n = 48) and Candida (n = 6). Seventeen cases died and 101 cases were cured.
CONCLUSIONS
SPE is a rare disease without specific clinical manifestations. For high-risk groups, such as intravenous drug users or patients with intravascular indwelling catheters, fever and imaging findings of multiple nodules or local infiltrates, with or without cavitation, are highly suggestive of SPE. Early diagnosis and prompt antimicrobial therapy or surgical intervention can lead to a successful treatment outcome.
Topics: Adult; Anti-Bacterial Agents; Bacteremia; Chest Pain; Cough; Early Diagnosis; Fever; Humans; Methicillin-Resistant Staphylococcus aureus; Pulmonary Embolism; Risk Factors; Staphylococcal Infections; Treatment Outcome
PubMed: 24183289
DOI: 10.1016/j.rmed.2013.10.012