Detection Rate Of Pulmonary Nodules Research Articles

Clinical application of two types of Hook-Wire needle localization procedures for pulmonary small nodule biopsy.

With the widespread use of low-dose spiral computed tomography (LDCT) and increasing awareness of personal health, the detection rate of pulmonary nodules is steadily rising. To evaluate the success rate and safety of two different models of Hook-Wire needle localization procedures for pulmonary small nodule biopsy. Ninety-four cases with a total of 97 pulmonary small nodules undergoing needle localization biopsy were retrospectively analyzed. The cases were divided into two groups: Group A, using breast localization needle steel wire (Bard Healthcare Science Co., Ltd.); Group B, using disposable pulmonary nodule puncture needle (SensCure Biotechnology Co., Ltd.). All patients underwent video-assisted thoracoscopic surgery (VATS) for nodule removal on the same day after localization and biopsy. The puncture localization operation time, success rate, complications such as pulmonary hemorrhage, pneumothorax, hemoptysis, and postoperative comfort were observed and compared. In Group A, the average localization operation time for 97 nodules was 15.47 ± 5.31 minutes, with a success rate of 94.34%. The complication rate was 71.69% (12 cases of pneumothorax, 35 cases of pulmonary hemorrhage, 2 cases of hemoptysis), and 40 cases of post-localization discomfort were reported. In Group B, the average localization operation time was 25.32 ± 7.83 minutes, with a 100% success rate. The complication rate was 29.55% (3 cases of pneumothorax, 15 cases of pulmonary hemorrhage, 0 cases of hemoptysis), and 3 cases reported postoperative discomfort. According to the data analysis in this study, Group B had a lower incidence of puncture-related complications than Group A, along with a higher success rate and significantly greater postoperative comfort. The disposable pulmonary nodule puncture needle is safer and more effective in pulmonary small nodule localization biopsy, exhibiting increased comfort compared to the breast localization needle. Additionally, the incidence of complications is significantly lower.

Analysis of the Prevalence Characteristics of Lung Nodules and Their Influencing Factors in The Health Check-Up Population

Objective: To study the prevalence characteristics of pulmonary nodules and their influencing factors in the health check-up population. Methods: A total of 500 cases of health checkups were selected for the data study to analyze the detection and prevalence characteristics of pulmonary nodules. The influencing factors between the pulmonary nodules group and the no pulmonary nodules group were analyzed. Results: A total of 209 cases were detected, of which there were more males than females, and for female patients, the detection rate increased with age (P < 0.05). The distribution of gender, age, smoking, respiratory symptoms, and exposure to kitchen fumes between the two groups was compared (P < 0.05). The multifactorial analysis concluded that risk factors include, respiratory symptoms, older age, exposure to kitchen fumes, and smoking. In addition, patients who exercised more had a lower risk of developing lung nodules. Conclusion: The detection rate of pulmonary nodules was high in the health check-up population and the influencing factors analyzed involved the presence of respiratory symptoms, older age, kitchen fume exposure, and smoking, while the positive influencing factor was increased exercise.

MiR-1246b, a novel miRNA molecule of extracellular vesicles in bronchoalveolar lavage fluid, promotes nodule growth through FGF14 in patients with lung cancer

With the widespread development of chest computed tomography (CT), the detection rate of pulmonary nodules has increased; therefore, the classification of benign vs. malignant nodules has become a common problem in the clinic. MicroRNA, a potential tool, is expected to become a good choice for diagnosing and studying the occurrence and development of diseases through the vector of bronchoalveolar lavage fluid extracellular vesicles (BALF-EVs). In this study, radial endobronchial ultrasound (R-EBUS) was used to locate pulmonary nodules in patients. BALF was obtained, EVs were isolated, and small RNA sequencing was performed to screen differentially expressed miRNAs between benign and malignant pulmonary nodules. The binding targets and underlying mechanisms of the differentially expressed miRNAs were verified by in vitro and in vivo experiments. R-EBUS localization and sampling was used to obtain BALF, and EVs were successfully isolated and characterized. Differentially expressed miRNAs in BALF-EVs of patients with benign vs. malignant pulmonary nodules were screened by high-throughput small RNA sequencing. A new miRNA, miR-1246b, was identified. We found that FGF14 was the binding target of miR-1246b by luciferase assay. Subsequent mechanistic studies showed that miR-1246b inhibited the expression of FGF14 in lung cancer cells, further leading to ERK phosphorylation and epithelial-to-mesenchymal transition (EMT), which ultimately contributed to lung cancer cell proliferation, migration and invasion. In summary, our study demonstrates that the detection of miRNAs in BALF-EVs, a means of liquid biopsy, could assist in distinguishing malignant nodules from benign nodules. miR-1246b, which was extracted from BALF-EVs, targets FGF14 to promote lung cancer cell proliferation, migration and invasion.

Lung CT stabilization with high-frequency non-invasive ventilation (HF-NIV) and breath-hold (BH) in lung nodule assessment by PET/CT

PurposeTo evaluate the effect of lung stabilization using high-frequency non-invasive ventilation (HF-NIV) and breath-hold (BH) techniques on lung nodule detection and texture assessment in PET/CT compared to a free-breathing (FB) standard lung CT acquisition in PET/CT.Materials and methodsSix patients aged 65 ± 7 years, addressed for initial assessment of at least one suspicious lung nodule with 18F-FDG PET/CT, underwent three consecutive lung PET/CT acquisitions with FB, HF-NIV and BH. Lung nodules were assessed on all three CT acquisitions of the PET/CT and characterized for any size, volume and solid/sub-solid nature.ResultsBH detected a significantly higher number of nodules (n = 422) compared to HF-NIV (n = 368) and FB (n = 191) (p < 0.001). The mean nodule size (mm) was 2.4 ± 2.1, 2.6 ± 1.9 and 3.2 ± 2.4 in BH, HF-NIV and FB, respectively, for long axis and 1.5 ± 1.3, 1.6 ± 1.2 and 2.1 ± 1.7 in BH, HF-NIV and FB, respectively, for short axis. Long- and short-axis diameters were significantly different between BH and FB (p < 0.001) and between HF-NIV and FB (p < 0.001 and p = 0.008), but not between BH and HF-NIV. A trend for higher volume was shown in FB compared to BH (p = 0.055) and HF-NIV (p = 0.068) without significant difference between BH and HF-NIV (p = 1). We found a significant difference in detectability of sub-solid nodules between the three acquisitions, with BH showing a higher number of sub-solid nodules (n = 128) compared to HF-NIV (n = 72) and FB (n = 44) (p = 0.002).ConclusionWe observed a higher detection rate of pulmonary nodules on CT under BH or HF-NIV conditions applied to PET/CT than with FB. BH and HF-NIV demonstrated comparable texture assessment and performed better than FB in assessing size and volume. BH showed a better performance for detecting sub-solid nodules compared to HF-NIV and FB. The addition of BH or HF-NIV to PET/CT can help improve the detection and texture characterization of lung nodules by CT, therefore improving the accuracy of oncological lung disease assessment. The ease of use of BH and its added value should prompt its use in routine practice.

Ability of three-dimensional 3-Tesla ultrashort echo time magnetic resonance imaging to display the morphological characteristics of pulmonary nodules: a sensitivity analysis.

Radiation-free lung cancer screening will reduce/eliminate radiation exposure in the diagnosis and follow-up of patients with lung cancer. This was a prospective study. The participants were recruited using convenience sampling. A total of 36 patients with pulmonary nodules [patients with single or multiple pulmonary nodules >4 and <30 mm on their pulmonary computed tomography (CT) scans] who were admitted to Fudan University Zhongshan Hospital's Xiamen branch were enrolled; they underwent a CT scan and a free-breathing ultrashort time-of-echo (UTE) sequence scan using a 3-Tesla (T) magnetic resonance imaging (MRI) scanner. The CT examinations were regarded as the reference standard. Patients had an interval time of <3 days between their CT and MRI examinations. Two reviewers with more than 10 years' experience in the diagnosis of pulmonary nodules identified the numbers and morphological features of the pulmonary nodules. Among the 36 patients, 46 nodules were detected on CT images, 45 of which were also detected on UTE images (a detection rate of 97.6%). The detection rate for lobulation using UTE-MRI was 96.9%; however, the difference compared with the rate for the CT images was not statistically significant (P>0.05). In terms of confounding lesions (confounding lesions indicate that the patient has malignant tumours, benign nodules or inoperable nodules), the UTE-MRI method had a higher detection rate than the CT method, and the difference was significant (P<0.05). The probability of malignant lesions was found to be higher in confounding lesions than in homogeneous lesions. In terms of pleural traction, the UTE-MRI method demonstrated a higher detection rate (120%) than the CT method, but the difference was not statistically significant (P>0.05). In terms of spiculation, the UTE-MRI method demonstrated a lower detection rate (81.8%) than the CT method, although the difference was not statistically significant (P>0.05). Overall, 3-T UTE-MRI imaging has a high detection rate for pulmonary nodules >4 mm and is similar to that of conventional CT imaging. The method can be used for radiation-free lung cancer screening and follow-up examinations to reduce/eliminate both repeat CT examinations and radiation damage.

Computed tomography-guided localization of pulmonary nodules prior to thoracoscopic surgery.

With the increasing awareness of physical examination, the detection rate of pulmonary nodules is gradually increasing. For pulmonary nodules recommended for management by video-assisted thoracic surgery (VATS), preoperative localization of the nodule is required if its location is difficult to determine intraoperatively by palpation. The computed tomography (CT)-guided preoperative localization technique is the most widely used method with low operational difficulty and high efficiency, which can include hook wire, microcoil, medical dye, medical surgical adhesive, combined application, and emerging localization techniques according to the material classification. Each method has its corresponding advantages and disadvantages, but there is still a lack of unified guidelines or standards for the selection of CT-guided preoperative localization methods in clinical practice. This review summarizes the operation precautions, advantages, and shortcomings of the above localization techniques in order to provide references for clinical application.

Intraoperative identification of pulmonary nodules during minimally invasive thoracic surgery: a narrative review.

The increasingly widespread application of computed tomography (CT) in the screening and follow-up of patients with lung disease has concomitantly increased the detection rate of pulmonary nodules. Currently, minimally invasive thoracic surgery (MITS) has become the preferred method of surgery for patients with pulmonary ground-glass nodules (GGNs) due to its advantages minimal invasiveness and rapid recovery. However, target nodule identification during MITS is sometimes challenging due to the inherent characteristics of these nodules, especially when they are small and distant from the pleura. This review details the many methods used for the intraoperative localization of pulmonary nodules. Literature published in the Cochrane Library, PubMed, ClinicalTrials, and China National Knowledge Infrastructure from 1990 to 2022 were searched and analyzed to obtain a comprehensive review of the different methods of identifying pulmonary nodules. Literature related to animal testing were excluded. An overview of the recent progress in the clinical methods for intraoperative localization of pulmonary nodules [including CT-guided percutaneous placement of markers; bronchoscopy-guided placement of markers; intraoperative ultrasonography; three-dimensional (3D) printing technology; artificial intelligence (AI); and intraoperative molecular imaging (IMI)] was conducted. The advantages and disadvantages, as well as the complications associated with existing research methods, were summarized to assist doctors in the development of optimized clinical strategies. Clinicians can communicate with the multidisciplinary team and select the appropriate positioning method according to each patient's individual situation and the available support of the equipment and technology of the institution. Certain non-invasive and specific identification methods may have clinical potential in pulmonary nodule localization in the future.

Comparison of Ultrashort TE Lung MRI and HRCT Lungs for Detection of Pulmonary Nodules in Oncology Patients.

Purpose The purpose of this study is to evaluate the detection rate of pulmonary nodules in ultrashort echo time (UTE) lung magnetic resonance imaging (MRI) and to compare it with computed tomography (CT) in oncology patients. Materials and Methods All individuals undergoing radiotherapy/chemotherapy/regular follow-up or visiting the oncology department and referred to radiology department for nodule detection, during the period of 1 year, were subjected to UTE lung MRI using the sequence Flash 3d_spiralvibe coronal 1.25 mm iso and high-resolution CT lungs and the images were analyzed. Results Among the total number of nodules detected in both lungs of all patients, nodules detected by CT were 241, and nodules detected by MRI were 212. The nodule detection rate by MRI was 87.96%. The detection rate of nodules for size equal to or more than 5 mm was nearly 100%. For nodules less than 5 mm, and equal to or more than 4 mm, MRI showed a comparable detection rate of 75%, while for nodules less than 4 mm, the detection rate was only 25%. Conclusion Our study results indicate that lung MRI had a near-complete detection rate for nodules equal to or more than 5 mm in size. Hence, in oncology patients who are undergoing regular follow-up of the lung nodules, lung MRI using UTE can replace low-dose CT, which in turn reduces the radiation dose to the patient.

Investigation on the incidence and risk factors of lung cancer among Chinese hospital employees.

ObjectiveIn recent years, the lung cancer incidence has grown and the population is younger. We intend to find out the true detection rate of pulmonary nodules and the incidence of lung cancer in the population and search for the risk factors.MethodHospital employees ≥40 years old who underwent low‐dose computed tomography (CT) lung cancer screening from January 2019 to March 2022 were selected to record CT‐imaging characteristics, pathology, staging, and questionnaires to investigate past history, smoking history, diet, mental health, etc. PM2.5 and radiation intake in radiation‐related occupation received monitoring in hospital.ResultThe detection rate of suspicious pulmonary nodules was 9.1% (233/2552), and the incidence rate of lung cancer (including adenocarcinoma in situ) was 4.0% (103/2552). Morbidity among doctors, nurses, technicians, administers, and logistics was no difference (p = 0.184), but higher in women than in men (4.7% vs 2.4% p = 0.002). The invasiveness increased with age and CT density of nodules (p = 0.018). The relationship between lung cancer morbidity and PM2.5 was not clear (p = 0.543); and no lung cancer has been found in employees related ionizing radiation.ConclusionThe high screening rate has brought about a high incidence of lung cancer. At present, the risk factor analysis of lung cancer based on small samples cannot find the direct cause. Most of the ground glass opacity (GGO)s detected by LDCT screening are indolent, but there are also rapidly progressive lung cancer. A predictive model to identify active and indolent GGO is necessary.

Technology update and field expansion of bronchoscopy interventional diagnosis in 2021

In recent years, with the rapid development of interventional pulmonary diseases, new instruments and new concepts are constantly updated. The increased detection rate of pulmonary nodules increases the demand of patients. These factors jointly promote the continuous progress of bronchoscopy diagnosis and treatment technology. The following techniques including thin/ultrathin bronchoscopes, radial probe endobronchial ultrasound (R-EBUS), and navigation bronchoscopy including virtual navigation bronchoscopy (VNB) and electromagnetic navigation bronchoscopy (ENB), robotic-assisted bronchoscopy (RAB), frozen biopsy for the diagnosis of diffuse lung diseases are particularly prominent and important in clinical practice. This paper reviews the progress and application of bronchoscopy in interventional diagnosis through the review of literature published in 2021.

Electromagnetic Navigation Bronchoscopy Integrated Non-intubated Uniportal VATS in Localization and Resection of Pulmonary Nodules.

BackgroundWith the development of computed tomography, the detection rate of pulmonary nodules is increasing. Accurate localization, minimally invasive resection, and rapid recovery are the most concentrated issues in modern thoracic surgery. However, some traditional procedures, including CT-guided localization and general intubated anesthesia, might prolong the operation and postoperative recovery. The integrated operating room provides a practical approach to achieve precise pulmonary nodule localization with real-time images using electromagnetic navigation bronchoscopy (ENB). Meanwhile, the minimally invasive video-assisted thoracoscopic surgery (VATS) under non-intubated anesthesia is also applied in the same place, enhancing operative efficiency and recovery after surgery.MethodThe patients with pulmonary nodules resection who underwent nodules localization and uniportal VATS under non-intubated anesthesia in the integrated operating room between September 2018 and December 2021 were identified and collected. They all received ENB localization before uniportal VATS under non-intubated anesthesia, provided by the same group of anesthesiologists and surgeons. Perioperative data of patients were analyzed and evaluated to demonstrate the feasibility and efficiency of the procedure.ResultA total of 243 patients with 251 pulmonary nodules underwent ICG staining localization by ENB. The mean calibration time and navigation time were 0.91 ± 0.43 min and 10.56 ± 7.24 min, respectively. Overall, successful navigation occurred in 248 (98.80%) nodules. All patients received thoracoscopic surgery after localization, including wedge resection (231, 92.03%), segmentectomy (13, 5.18%), and lobectomy (7, 2.79%). All nodules were completely resected without serious complications. The mean postoperative hospital was 1.80 ± 0.83 days.ConclusionENB localization and nodules resection under non-intubated uniportal VATS in the integrated operating room provides a feasible and efficient approach to the pulmonary nodules patients, favoring the treatment precision and enhanced recovery.

Analysis of lung cancer screening through low-dose spiral computed tomography among petroleum company staffs in Sichuan-Chongqing Area in 2020

Objective: To provide scientific evidence for early lung cancer screening, to analyze the incidence of pulmonary nodules among petroleum company staffs in Sichuan-Chongqing Area. Methods: In January 2021 , 6002 petroleum company staffs in Sichuan-Chongqing Area which scanned by low-dose spiral computed tomography (LDCT) of chest in medical examination center in 2020 were retrospectively collected as objects. Their imaging and clinical data were collected. χ(2) test was used to analyze the differences in the detection rates of lung nodules and suspected lung cancer nodules among workers in petroleum company staffs of different genders, ages and types of work. Results: Among the 6002 objects, 3853 (64.2%) were male and 2149 (35.8%) were female, with an average age of (47.25±12.13) years old. A total of 431 cases (7.2%) of pulmonary nodules and 57 cases (0.9%) of suspected lung cancer nodules were detected. 45 cases were followed up with surgical treatment, and 41 cases (91.1%) of lung cancer were diagnosed by postoperative pathology. There were significant differences in the detection rates of pulmonary nodules and suspected lung cancer nodules between different age groups (χ(2)=51.23, 18.81 , P<0.001). The detection rates of pulmonary nodules in the age groups 51-60 years old and ≥61 years old were higher than those in the age groups≤40 years old and 41-50 years old (P<0.05). The detection rate of suspected lung cancer nodules in the age group≥ 61 years old was higher than those in the age groups≤40 years old, 41-50 years old and 51-60 years old (P< 0.05) . And the detection rate of suspected lung cancer pulmonary nodules in oil workers was higher than that of ordinary workers (P<0.05) . Among female objects, the detection rate of pulmonary nodules in oil workers was higher than that in ordinary workers (χ(2)=8.09, P=0.004) . The detection rate of pulmonary nodules in oil workers aged ≥61 years old was higher than ordinary workers (χ(2)=37.94, P<0.001) . Among male objects, the detection rate of suspected lung cancer pulmonary nodules in oil workers was higher than that in ordinary workers (χ(2)=8.42, P=0.004) . The detection rates of suspected lung cancer pulmonary nodules in oil workers aged 51-60 years old and ≥61 years old groups were higher than those of ordinary workers (χ(2)=4.70, 8.74; P=0.030, 0.003) . Conclusion: LDCT is suitable for early lung cancer screening for petroleum company staffs. During the clinical screening process, LDCT should be used as a routine physical examination item for petroleum workers older than 51 years old.

Improved cost-sensitive multikernel learning support vector machine algorithm based on particle swarm optimization in pulmonary nodule recognition

In the lung computer-aided detection (Lung CAD) system, the region of interest (ROI) of lung nodules has more false positives, making the imbalance between positive and negative (true positive and false positive) samples more likely to lead to misclassification of true positive nodules, a cost-sensitive multikernel learning support vector machine (CS-MKL-SVM) algorithm is proposed. Different penalty coefficients are assigned to positive and negative samples, so that the model can better learn the features of true positive nodules and improve the classification effect. To further improve the detection rate of pulmonary nodules and overall recognition accuracy, a score function named F-new based on the harmonic mean of accuracy (ACC) and sensitivity (SEN) is proposed as a fitness function for subsequent particle swarm optimization (PSO) parameter optimization, and a feasibility analysis of this function is performed. Compared with the fitness function that considers only accuracy or sensitivity, both the detection rate and the recognition accuracy of pulmonary nodules can be improved by this new algorithm. Compared with the grid search algorithm, using PSO for parameter search can reduce the model training time by nearly 20 times and achieve rapid parameter optimization. The maximum F-new obtained on the test set is 0.9357 for the proposed algorithm. When the maximum value of F-new is achieved, the corresponding recognition ACC is 91%, and SEN is 96.3%. Compared with the radial basis function in the single kernel, the F-new of the algorithm in this paper is 2.16% higher, ACC is 1.00% higher and SEN is equal. Compared with the polynomial kernel function in the single kernel, the F-new of the algorithm is 3.64% higher, ACC is 1.00% higher and SEN is 7.41% higher. The experimental results show that the F-new, ACC and SEN of the proposed algorithm is the best among them, and the results obtained by using multikernel function combined with F-new index are better than the single kernel function. Compared with the MKL-SVM algorithm of grid search, the ACC of the algorithm in this paper is reduced by 1%, and the results are equal to those of the MKL-SVM algorithm based on PSO only. Compared with the above two algorithms, SEN is increased by 3.71% and 7.41%, respectively. Therefore, it can be seen that the cost sensitive method can effectively reduce the missed detection of nodules, and the availability of the new algorithm can be further verified.

Computed tomography findings, associated factors, and management of pulmonary nodules in 54,326 healthy individuals.

To investigate the pulmonary nodules detected by low-dose computed tomography (LDCT), identified factors affecting the size and number of pulmonary nodules (single or multiple), and the pulmonary nodules diagnosed and management as lung cancer in healthy individuals. A retrospective analysis was conducted on 54,326 healthy individuals who received chest LDCT screening. According to the results of screening, the detection rates of pulmonary nodules, grouped according to the size and number of pulmonary nodules (single or multiple), and the patients' gender, age, history of smoking, hypertension, and diabetes were statistically analyzed to determine the correlation between each factor and the characteristics of the nodules. The pulmonary nodules in healthy individuals diagnosed with lung cancer were managed with differently protocols. The detection rate of pulmonary nodules was 38.8% (21,055/54,326). The baseline demographic characteristics of patients with pulmonary nodules were: 58% male and 42% female patients, 25.7% smoking and 74.3% nonsmoking individuals, 40-60 years old accounted for 49%, 54.8% multiple nodules, and 45.2% single nodules, and ≤5-mm size accounted for 80.4%, 6-10 mm for 18.2%, and 11-30 mm for 1.4%. Multiple pulmonary nodules were more common in hypertensive patients. Diabetes is not an independent risk factor for several pulmonary nodules. Of all patients with lung nodules, 26 were diagnosed with lung cancer, accounting for 0.1% of all patients with pulmonary nodules, 0.6% with nodules ≥5 mm, and 2.2% with nodules ≥8 mm, respectively. Twenty-six patients with lung cancer were treated with surgical resection (57.7%), microwave ablation (MWA, 38.5%), and follow-up (3.8%). LDCT was suitable for large-scale pulmonary nodules screening in healthy individuals, which was helpful for the early detection of suspicious lesions in the lung. In addition to surgical resection, MWA is an option for early lung cancer treatment.

Free-breathing radial 3D fat-suppressed T1-weighted gradient echo (r-VIBE) sequence for assessment of pulmonary lesions: a prospective comparison of CT and MRI

PurposeTo determine whether the pulmonary MR imaging with free-breathing radial 3D fat-suppressed T1-weighted gradient echo (r-VIBE) sequence can detect lung lesions and display lesion profiles with an accuracy comparable to that of computed tomography (CT), which is the reference standard in this study.PopulationSixty-three consecutive patients were prospectively enrolled between October, 2016 and March, 2017. All the patients received both 3T MRI scanning with a free-breathing r-VIBE sequence and chest standard CT. Morphologic features of lesions were evaluated by two radiologists with a 5-point system. Chest standard CT were used as reference standard. Weighted kappa analysis and chi-squared test were used to determine both inter-observer agreement and inter-method agreement.ResultsA total of 210 solid pulmonary nodules or masses and 1 ground-glass nodule were detected by CT. Compared to CT, r-VIBE correctly detected 95.7% of pulmonary nodules, including 100% of detection rate with diameter greater than 6 mm, 92.3% of pulmonary nodules with diameter between 4 and 6 mm, and 83.3% of pulmonary nodules with diameter less than 4 mm The inter-method agreements between r-VIBE and standard-dose CT were either “substantial” or “excellent” in the evaluation of following features of pulmonary nodules with diameter more than 10mm: including lobulation, spiculation, convergence of vessels, bubble-like attenuation, cavitation and mediastinal lymph node enlargement (0.605≤K≤1.000; P<0.0001). However, K values for inter-method agreements were significant but “moderate” or “poor” for evaluating pleural tag, halo, and calcification (0.355≤ K≤0.451; P<0.0001).ConclusionThe use of pulmonary MR imaging with r-VIBE showed high detection rate of pulmonary nodules and inter-method agreement with CT. It is also useful for nodule morphologic assessment.

P02.01 CT Integrated Bronchoscopy Manual Spraying Pigment Labeling to Localize of Small Pulmonary Nodules

Popularization of High Resolution Computed Tomography (HRCT) has greatly improved the detection rate of pulmonary nodules. Video Assistant Thoracic Surgery (VATS) lobectomy (sublobar lung resection in selected patients) has been the standard surgical treatment for these early stage non-small cell lung cancer. Uniportal VATS, a widely used innovative technique in minimally invasive thoracic surgery, makes less incision and also demands more precise intraoperative palpation/localization which is often challenging for small nodules. Various strategies such as the hookwire method, CT fluoroscopy-guided bronchoscopic dye marking, contrast median injection, radiotracer localization and a virtual assisted lung mapping technology (VAL-MAP). While they provide new options of nodule location for thoracic surgeons, all of these strategies require expensive hardware or software and additional two or three more doctors which are often not affordable for centers with limited resources. The purpose of this study is to develop a practically cheap method of pigment labeling for bronchoscope with no additional need of medical equipment and medical human resources. This is an ethic committee approved clinical trial. Medically operable patients with the HRCT detected small nodules were eligible. This nodule localization method involved a manual drawing the route by the surgeon/bronchoscopist, through a series of bronchial opening sketches and marking the leading bronchus at every bifurcation point based on the HRCT. Two to four appropriate bronchial pathways were selected for each lesion. A metal-tip catheter was inserted into a selected bronchus and advanced to the pleura. The location of the catheter tip was fluoroscopically confirmed, and 1 mL of diluted methylene blue was injected for each marking. All these procedures were completed by one doctor and one nurse. Then low dose CT scan was used to visualize the localization of the multiple markings, which were used as references in the subsequent operation. Success rate and procedure related complication are reported. From April 2019 to July 2020, 18 lesions in 17 patients were enrolled. All surgical procedures were performed using uniportal VATS. The lesions ranged in size from 3 to 23mm, 15 (83%) were nodules of Ground Glass Opacity (GGO). The depth ranged from 0 to 19 mm. A total of 57 lung markings were planned. 54 of them (95%) were completed. Of the 3 failed markings, the target bronchus could not be accessed under the bronchoscopy because of improper angle. Fifty-two (91%) were visible during the operations. The 3 unidentified markings were in the same patient, who had been a coal miner and had a severe carbon deposition on his lung and pleura. There was no adverse event associated with this manual marking procedures. All lesions were successfully resected. In 3 patients failed multiple markings, alternative localization was used successfully. This HRCT guided manual drawing method of lesion localization is safe and effective for small nodule localization for lung cancer surgery. Results of this study appears to be better than conventional percutaneous techniques in clinically evident complications. Because it does not need special equipment, it is more suitable for developing countries with limited equipment and human resources.

Lung cancer screening with low-dose spiral CT in a unit staff: Results of the baseline screening

To analyze the incidence and imaging characteristics of pulmonary nodules in a unit staff. Methods: Low-dose spiral CT (LDCT) scan were performed in 1 372 staffs ≥45 years old in a certain unit during the physical examination. The clinical and imaging data were collected to analyze the detection rate, imaging characteristics, and postoperative pathological conditions of pulmonary nodules. Results: The total detection rate for pulmonary nodules was 30.39% (417/1 372). The detected nodules were mainly single (227 cases), solid (343 cases), <5 mm in diameter (261 cases), and Lung-Reporting and Data System (Lung-RADS) category 2 nodules (340 cases). The single nodules were mostly found in the right upper lung (74 cases, 32.60%). The detection rate of pulmonary nodules tended to decrease but the detection rate of category 4 nodules increased with the increasing age (P<0.05), while the gender had no significant influence on the detection rate (P>0.05). Compared with the Lung-RADS category 3 nodules, the proportions of nodules in subsolid state, with irregular shape, lobulation sign, and vascular penetration in the Lung-RADS category 4 were increased (all P<0.05). Among them, 11 patients received surgical therapy, including 10 women. Postoperative pathology confirmed lung adenocarcinoma in 9 patients (2.16%), including 8 women, all non-smokers. Conclusion: The nodules in subsolid state with vascular penetration, irregular shape and lobulation sign tend to be malignant. Lung cancer screening with low-dose spiral CT in female non-smokers should be emphasized.

Artificial intelligence evaluation of simulated phantom lung nodules with different pre-adaptive iteration techniques

Objective: To investigate the detection rate of pulmonary nodules and the accuracy of automated measurement in chest simulation phantom by artificial intelligent computer-aided detection of pulmonary nodules with different pre-adaptive iterative techniques (ASIR-V) in wide-spectrum CT scanning. Methods: Sixteen pulmonary nodules with different diameters, densities and shapes were placed in the chest simulation phantom from December 2017 to March 2018. The weight of ASIR-V was set at 0%, 20%, 30%, 40% and 50% respectively by using Revolution CT broadband energy spectrum scanning protocol. Spearman correlation analysis was used to analyze the dose volume CT dose index (CTDIvol) and dose length product (DLP) of each group. Scanning data were imported into Tuma Shenwei artificial pulmonary nodule analysis software to evaluate the nature of the detected nodules, and ICC was used to detect the differences among groups. Results: With the increase of ASIR-V weight, the effective dose of patients decreased gradually. CTDIvol of five groups of radiation dose volume CT dose index was 7.93, 7.24, 5.85, 5.15, 3.76 mGy,dose-length product DLP was 379, 346, 280, 246, 179 mGy·cm.There was a linear negative correlation between ASIR-V weights and CTDIvol as well as DLP, r value was-0.969, P<0.01.There was no significant difference in the detection rate of pulmonary nodules between AI and physicians (P>0.05). There was high intraclass correlation coefficients for the diameter, volume, CT value and malignant percentage of pulmonary nodules (ICCs:0.981-1.000). Conclusions: Radiation dose of unenhanced chest CT scan using wide detector spectral imaging decreased with the increasing of preset ASIR-V. Lung nodule detection rate and evaluation performance can be maintained well by using ASIR-V reconstructions at lower radiation dosage.

Integration of fully automated computer-aided pulmonary nodule detection into CT pulmonary angiography studies in the emergency department: effect on workflow and diagnostic accuracy.

To assess the feasibility of implementing fully automated computer-aided diagnosis (CAD) for detection of pulmonary nodules on CT pulmonary angiography (CTPA) studies in emergency setting. CTPA of 48 emergency patients was retrospectively reviewed. Fully automated CAD nodule detection was performed at the scanner and results were automatically submitted to PACS. A third-year radiology resident (RAD1) and a cardiothoracic radiologist with 6years' experience (RAD2) reviewed the scans independently to detect pulmonary nodules in two different sessions 8weeks apart: session 1, CAD was reviewed first and then all images were reviewed; session 2, CAD was reviewed last after all images were reviewed. Time spent by RAD to evaluate image sets was measured for each case. Fisher's exact test and t test were used. There were 17 male and 31 female patients with mean ± SD age of 48.7 ± 16.4years. Using CAD at the beginning was associated with lower average reading time for both readers. However, difference in reading time did not reach statistical significance for RAD1 (RAD1 94.6s vs. 102.7s, P > 0.05; RAD2 61.1s vs. 76.5s, P < 0.05). Using CAD at the end significantly increased rate of RAD1 and RAD2 nodule detection by 34% (2.52 vs. 2.12 nodule/scan, P < 0.05) and 27% (2.23 vs. 1.81 nodule/scan, P < 0.05), respectively. Routine utilization of CAD in emergency setting is feasible and can improve detection rate of pulmonary nodules significantly. Different methods of incorporating CAD in detecting pulmonary nodules can improve both the rate of detection and interpretation speed.

Evaluation of detection rate of pulmonary nodules and the reasons may affect their visibility on chest radiograms

Evaluation of detection rate of pulmonary nodules and the reasons may affect their visibility on chest radiograms