5,995 publications found
Sort by
Rate of benign nodule resection in a lung cancer screening program.

Screening with low dose computed tomography (CT) can reduce lung cancer related death at the expense of unavoidable false positive results. The purpose of this study is to measure the rate of surgery for benign nodules, and evaluate characteristics of those nodules. In this study, we evaluated patients in the Lung Cancer Screening (LCS) program across a large tertiary healthcare network from 5/2015 through 10/2021 who underwent surgical resection for a lung nodule. We reviewed the pathology reports and subsequent follow-up to establish whether the nodule was benign or malignant. Imaging characteristics of the nodules were evaluated by a radiology fellow, and we recorded Lung-RADS category, nodule status (baseline, stable, new, growing), FDG uptake on PET/CT, and calculated the risk from the Brock model. During this time period, a total of 21,366 LCS CT was performed in 9050 patients, and 260 patients underwent a following surgical resection. Review of the pathology results revealed: 220 lung cancer (85%), 2 other malignancies (1%), and 38 benign findings (15%). Pathology of the benign nodules was as follows: 12 with scarring/fibrosis, 5 with benign neoplasms, 14 with infection/inflammation, and 7 with other diagnoses. Lung-RADS category was as follows: 4 (11%) Lung-RADS 2, 2 (5%) Lung-Rad 3, 11 (29%) Lung-RADS 4A, 13 (34%) Lung-RADS 4B, and 8 (21%) Lung-RADS 4X. The size of the nodules ranged from 4 to 41mm with a median of 13mm. 2 (5%) were ground glass, 10 (26%) were part-solid, and 26 (68%) were solid. FDG-PET/CT was performed in 19 out of 38 cases, of which: 2 (11%) had no uptake, 10 (53%) had mild uptake, 3 (16%) had moderate uptake, and 4 (21%) had intense uptake. Risk assessment by Brock calculator revealed that 9 (24) had <5% (very low) risk; 27 (71%) had 5-65% (low-intermediate) risk, and 2 (5%) had >65% (high) risk. Surgical resection of benign nodules is unavoidable despite application of Lung-RADS guidelines in a modern screening program, with approximately 15% of surgeries being done for benign lesions.

Just Published
Management of screening-detected lobular neoplasia in the era of digital breast tomosynthesis: A preliminary study.

The purpose of this study is to determine upgrade rates of lobular neoplasia detected by screening digital breast tomosynthesis (DBT) and to determine imaging and clinicopathological features that may influence risk of upgrade. Medical records were reviewed of consecutive women who presented with screening DBT-detected atypical lobular hyperplasia (ALH) and/or lobular carcinoma in situ (LCIS) from January 1, 2013, to June 30, 2020. Included patients underwent needle biopsy and had surgery or at least two-year imaging follow-up. Imaging and clinicopathological features were compared between upgraded and nonupgraded cases of lobular neoplasia using the Pearson's chi-squared test and the Wilcoxon signed-rank test. During the study period, 107 women (mean age 55years, range 40-88years) with 110 cases of ALH and/or LCIS underwent surgery (80.9%, n=89) or at least two-year imaging follow-up (19.1%, n=21). The overall upgrade rate to cancer was 5.5% (6/110), and the upgrade rate to invasive cancer was 3.6% (4/110). The upgrade rate of ALH to cancer was 4.1% (3/74), whereas the upgrade rate of LCIS to cancer was 9.4% (3/32) (p=.28). The upgrade rate of cases presenting as calcifications was 4.2% (3/71), whereas the upgrade rates of cases presenting as noncalcified findings was 7.7% (3/39) (p=.44). The upgrade rate of screening DBT-detected lobular neoplasia is less than 6%. Surveillance rather than surgery can be considered for lobular neoplasia, particularly in patients with ALH and in those with screening-detected calcifications leading to the diagnosis.

Establishing quantitative radiographic criteria for the diagnosis of pleuroparenchymal fibroelastosis.

Pleuroparenchymal Fibroelastosis (PPFE) is a type of pulmonary fibrosis most commonly occurring at the apices. Patients with PPFE have an increased risk of adverse effects from lung biopsy and in the post-surgical setting. Here, we investigated simple and reproducible measurements on chest CT to evaluate their predictive value in diagnosing PPFE. We analyzed a cohort of patients with histologically-proven PPFE and compared them to a cohort of patients diagnosed with "biapical scarring" (BAS) on chest CT. We measured plueuroparenchymal thickness using several independent parameters on chest CT. We also assessed other radiologic and clinical characteristics to identify if any were predictive of PPFF. Our analysis demonstrated the average greatest apical thickness with a cut off of 4.5mm yielded a sensitivity of 94.4% and a specificity of 88.9%, and an area under the curve of 97.2%. Single greatest apical thickness with a cut off of 7.5mm had a sensitivity of 100% and a specificity of 88.9%, with the area under the curve of 97.8%. Average greatest upper lobe thickness with a cut off of 8.0mm had a sensitivity of 88.9% and a specificity of 100%, with an area under the curve of 98.2%. Single greatest upper lobe thickness with a cut off of 8.5 yielded both a sensitivity and specificity of 94.4% and an area under the curve of 94.3%. Measurements described above are highly sensitive and specific for the diagnosis of PPFE and warrant investigation with a larger cohort of patients.

Mid-to-long-term outcomes with image-guided placement of de novo low-profile gastrojejunostomy tubes in pediatric patients.

De novo low-profile gastrojejunostomy (GJ) tubes are advantageous in children that require prolonged supplemental nutrition. However, few institutions place these devices at the time of initial feeding tube placement. We aim to build upon our previously published initial experience with this procedure to study mid-to-long-term outcomes of pediatric patients who have had de novo, image-guided, percutaneous low-profile GJ tube placement. All de novo, image-guided, percutaneous, low-profile GJ tube placements at a single children's hospital were retrospectively reviewed between May 2014 and March 2021. Technical parameters, including fluoroscopy time, tube size, technical success, and complications were recorded. Clinical data, including age, indication, weight gain and transition to gastric/oral feeds were analyzed. 64 de novo low-profile GJ tubes were successfully placed in 65 patients (mean age: 4.6years, median: 1, range: 0.2-19; mean pre-procedural weight: 16.8kg, median: 8.2, range: 4.4-66.7). Average clinical follow-up 23.4months (range: 0.1-75, median 10.4). Average weight gain was 6.1kg. Average increase in weight percentile was 7.3%. 19 (19/64; 29.7%) patients had conversion from GJ to G tube. 11 (11/64; 17.2%) patients had their enteric tube removed completely. There were 7 minor complications (7/65; 10.7%), most common being excessive skin irritation (6/7) and 9 major complications (9/65; 13.8%), most common being tube dislodgment within the first 30days (6/9). These results further support that de novo, image-guided, percutaneous, low-profile GJ tube placement is technically feasible and efficacious in children requiring post-pyloric nutritional supplementation with a favorable safety profile.

Open Access
CT-derived coronary artery calcium density is affected by regional lesion distribution and image reconstruction parameters.

The prognostic relevance of coronary artery calcium (CAC) density, assessed from cardiac CT scans, is established. However, the influence of CAC distribution, volume, image reconstruction, and clinical factors on CAC density warrants further examination. In this study, 120 patients underwent non-contrast ECG-gated cardiac CT scans using a prospectively defined CAC scoring protocol with 1-, 3-, and 5-mm thick image reconstructions, both with and without a 20% image overlap. We segmented CAC in all reconstructions and assessed the relationship between CAC density, volume, and number of detected calcifications/patient. Overall, 75/120 (63%) patients (66% men, mean age 63±11years) presented CAC across 342 segments. CAC density, CAC volume, and the number of detected calcifications decreased with increasing slice thickness (p<0.001 for all); these effects were slightly reduced by image overlap (p<0.001 for all). Higher CAC density correlated with greater CAC volume (ρ=0.62; p<0.001) and more calcified segments per person (ρ=0.32; p=0.006). Higher CAC density was also associated with lower patient weight (beta: -0.6, 95%CI: -1.1--0.1, p=0.022) and increased high-density lipoprotein (HDL) levels (beta: 0.7, 95%CI: 0.0-1.4, p=0.046). In a multivariable analysis adjusted for clinical covariates, lower CAC density was associated with broader CAC distribution (i.e., a higher number of calcified segments at a given CAC volume; beta-coefficient: -58.9; 95%CI: -84.7 to -33.1; p<0.001). CAC density is significantly impacted by regional CAC distribution and image reconstruction, potentially confounding its prognostic value. Accounting for these factors may improve patient risk assessment, management, and cardiovascular health outcomes.