Nodule Grade Research Articles

A nomogram combining thoracic CT and tumor markers to predict the malignant grade of pulmonary nodules ≤3 cm in diameter.

With the popularity of computed tomography (CT) of the thorax, the rate of diagnosis for patients with early-stage lung cancer has increased. However, distinguishing high-risk pulmonary nodules (HRPNs) from low-risk pulmonary nodules (LRPNs) before surgery remains challenging. A retrospective analysis was performed on 1064 patients with pulmonary nodules (PNs) admitted to the Qilu Hospital of Shandong University from April to December 2021. Randomization of all eligible patients to either the training or validation cohort was performed in a 3:1 ratio. Eighty-three PNs patients who visited Qianfoshan Hospital in the Shandong Province from January through April of 2022 were included as an external validation. Univariable and multivariable logistic regression (forward stepwise regression) were used to identify independent risk factors, and a predictive model and dynamic web nomogram were constructed by integrating these risk factors. A total of 895 patients were included, with an incidence of HRPNs of 47.3% (423/895). Logistic regression analysis identified four independent risk factors: the size, consolidation tumor ratio, CT value of PNs, and carcinoembryonic antigen levels in blood. The area under the ROC curves was 0.895, 0.936, and 0.812 for the training, internal validation, and external validation cohorts, respectively. The Hosmer-Lemeshow test demonstrated excellent calibration capability, and the fit of the calibration curve was good. DCA has shown the nomogram to be clinically useful. The nomogram performed well in predicting the likelihood of HRPNs. In addition, it identified HRPNs in patients with PNs, achieved accurate treatment with HRPNs, and is expected to promote their rapid recovery.

Characteristics of Ground-Glass Nodules Detected by Low-Dose Computed Tomography as a Regular Health Examination Among Chinese Hospital Employees and Their Parents.

IntroductionAnnual LDCT has been offered as a regular examination among many unit staff in China. Along with the wide application of LDCT, more and more ground-glass nodules were found. We focused on characteristics and relationship of ground-glass nodules detected by LDCT as a regular health examination among Chinese hospital employees and their parents.MethodsWe recorded LDCT-detected ground-glass nodules (GGNs) in the hospital employees and parents between 2019 and 2020. Clinical information, including age, gender, smoking status was collected and analyzed.ResultsA total of 5,574 employees and 2,686 employs’ parents ≥60 years in Xiangya hospital performed annual physical examination. In total, LDCT incidentally detected ground-glass nodules 392 (24.78%, 392/1,582) in hospital employees and 254 in parents (10.80%, 254/2,352). The GGN-detection rate was significantly greater in employee group than parent group and more non-smokers in former (P <0.001). The detection rate was significantly greater in female than male both in employees group and parents group, and the proportion of female was bigger in employees group (P <0.001). There were more pure-GGNs both in employees group and parents group. There were less participants with solitary GGN in employee group than parent group (P = 0.033). Besides, there were more large GGNs (≥10 mm) (P <0.001), LU-RADS 4 GGNs (P <0.001) and LU-RADS 4B GGNs (P = 0.003), LU-RADS 4C-5 GGNs (P = 0.001) in parent group than employee group. There were 36 employee–parent pairs (27.07%) both had GGNs among 133 pairs who both performed LDCT. GGNs in employees were smaller and lower-grade than their parents (P < 0.001, P = 0.001).ConclusionsAmong the employees and parents who had ground glass nodules, 1/4 of them both detected GGNs. Although the detection rate of GGNs in the parent group was lower than that in the employee group, the grade of nodules was significantly higher. All these suggest that the occurrence and development of ground glass nodules may be related to genetic factors.

Preliminary Investigation and Imaging Analysis of Early Lung Cancer Screening Among Petroleum Workers in North China

Background The detection rate of lung nodules has increased significantly among petroleum workers in North China since the low-dose CT (LDCT) screening has been widely carried out. What's more, the number of confirmed early lung cancers is increasing continuously. Therefore, a great deal of concern for the high risk of lung cancer has been shown among petroleum workers. Purpose To improve the screening efficiency and maximize the benefits of the subjects, the current situation of LDCT lung cancer screening should be understood and the imaging characteristics of early lung cancer should be analyzed for petroleum workers in North China. Materials and methods Firstly, the dynamic changes of LDCT early lung cancer screening for petroleum workers in North China were analyzed in recent years. Then, the survey data of 3121 petroleum workers was compared with that of 1868 non-petroleum workers, which was analyzed. Finally, 91 patients (129 nodular lung cancer) confirmed by pathology were retrospectively analyzed, and the data of which was compared with the clinical features obtained from survey data above. The imaging characteristics and related factors of different subtypes of lung adenocarcinoma were discussed and analyzed. Results Lung nodules were found in 810 cases (25.95%) out of 3121 petroleum workers; and the surgery was chosen by 42 patients, 38 of whom were confirmed as lung cancer. Compared with the data of screened petroleum workers, there were more older people and more females as well as a higher proportion of people with family malignancy history, and a lower proportion of smoking people in 91 patients with lung cancer. As the pathological grade of tumor nodules increased, the volume and diameter of nodules gradually increased, and the mean density, maximum density and standard deviation of density also increased (p < 0.001). The volume and diameter of nodules were positively correlated with ages (p < 0.05). Conclusion The occurrence of lung adenocarcinoma is closely related to the family history of malignant tumors, and the constituent ratio of young women without a history of smoking increased significantly. At the same time, the quantitative information obtained by using CT images has important value in predicting its pathological subtypes.

Pediatric dysphonia: It's not about the nodules

ObjectiveDespite the fact that vocal nodules are the most common cause of chronic dysphonia in children, uncertainty and lack of consensus complicates practically every diagnostic and management decision. Selecting an optimal staging system is fundamental to understanding a disease process, mandatory for uniform reporting, and crucial to predicting natural history and treatment outcomes. The ideal prognostic model for vocal nodules is under intense debate. The purpose of this study was to analyze the predictive power of vocal nodule grade to severity of voice metrics in children. MethodsSeventy-nine patients diagnosed with vocal cord nodules between 2006 and 2012 were drawn from UPMC Children's Hospital of Pittsburgh Voice, Resonance and Swallowing Center Research Registry. Subject age at time of diagnosis, nodule grade, relevant co-morbidities, scores on The Consensus Auditory-Perceptual Evaluation of Voice (CAPE-V), parent-reported Pediatric Voice Handicap Index (pVHI), the phonotraumatic behaviors profile, habitual speaking pitch fundamental frequencies, pitch range, volume intensity, and s/z ratio were recorded and compiled into a de-identified database for analysis. ResultsBased on the Kruskal-Wallis H Test, there was no statistically significant correlation between nodule grade and total pitch range (p = .21), s/z ratio (p = .50), volume intensity (p = .33), overall CAPE-V Scores (p = .15), or pVHI Scores (p = .29). Chi-squared tests also revealed no significant associations between nodule grade and abnormality in habitual speaking pitch (p = .14 for fundamental frequency while sustaining a vowel sound, p = .37 for fundamental frequency while speaking structured tasks i.e. counting, or p = .76 while speaking in conversation). ConclusionThe current “gold-standard” for grading vocal nodule size suggests that the nodules themselves are not driving the standard dysphonic metrics that are most commonly collected and monitored in such children. This outcome is consistent with other studies reporting similar findings and was expected based on the inconsistencies in the reported literature to date. By extension, the conventional wisdom of avoiding surgical treatment of vocal nodules in children seems prudent as there is little evidence to suggest that the nodules themselves are “driving” the severity of the dysphonia. Ultimately identifying the true “drivers” of dysphonia in children will suggest alternative therapies that are more specific and directed to the pathophysiology. Most pediatric voice care professionals will welcome such discoveries as those in the front line of patient care are often rendered helpless and frustrated.

Computer-aided diagnosis of ground-glass opacity pulmonary nodules using radiomic features analysis

This study aims to develop a CT-based radiomic features analysis approach for diagnosis of ground-glass opacity (GGO) pulmonary nodules, and also assess whether computer-aided diagnosis (CADx) performance changes in classifying between benign and malignant nodules associated with histopathological subtypes namely, adenocarcinoma in situ (AIS), minimally invasive adenocarcinoma (MIA), and invasive adenocarcinoma (IAC), respectively.The study involves 182 histopathology-confirmed GGO nodules collected from two cancer centers. Among them, 59 are benign, 50 are AIS, 32 are MIA, and 41 are IAC nodules. Four training/testing data sets—(1) all nodules, (2) benign and AIS nodules, (3) benign and MIA nodules, (4) benign and IAC nodules—are assembled based on their histopathological subtypes. We first segment pulmonary nodules depicted in CT images by using a 3D region growing and geodesic active contour level set algorithm. Then, we computed and extracted 1117 quantitative imaging features based on the 3D segmented nodules. After conducting radiomic features normalization process, we apply a leave-one-out cross-validation (LOOCV) method to build models by embedding with a Relief feature selection, synthetic minority oversampling technique (SMOTE) and three machine-learning classifiers namely, support vector machine classifier, logistic regression classifier and Gaussian Naïve Bayes classifier.When separately using four data sets to train and test three classifiers, the average areas under receiver operating characteristic curves (AUC) are 0.75, 0.55, 0.77 and 0.93, respectively. When testing on an independent data set, our scheme yields higher accuracy than two radiologists (61.3% versus radiologist 1: 53.1% and radiologist 2: 56.3%).This study demonstrates that: (1) the feasibility of using CT-based radiomic features analysis approach to distinguish between benign and malignant GGO nodules, (2) higher performance of CADx scheme in diagnosing GGO nodules comparing with radiologist, and (3) a consistently positive trend between classification performance and invasive grade of GGO nodules. Thus, to improve the CADx performance in diagnosing of GGO nodules, one should assemble an optimal training data set dominated with more nodules associated with non-invasive lung adenocarcinoma (i.e. AIS and MIA).

Expression and prognostic significance of p21-activated kinase 6 in hepatocellular carcinoma

Backgroundp21-activated protein kinase (PAK) 6 is a serine-threonine kinase belonging to the PAK family. Previous studies have indicated that abnormal expressions of PAK1, PAK2, and PAK5 played critical roles in hepatocellular carcinoma (HCC). Recent studies suggested that deregulation of PAK6 expression played an important role in oncogenesis. To explore the potential roles of PAK6 in HCC, expression of PAK6 was detected in human HCC specimens. MethodsImmunohistochemistry and Western blot analysis were performed for PAK6 in 121 HCC samples. The data were correlated with clinicopathologic features. The univariate and multivariate survival analyses were also performed to determine their clinical prognostic significance. ResultsPAK6 was overexpressed in HCC as compared with the adjacent noncancerous liver tissues. High expression of PAK6 was associated with Edmondson–Steiner grade (P = 0.006) and number of tumor nodules (P < 0.001), and PAK6 was positively correlated with proliferation marker Ki-67 (P < 0.01). Univariate analysis suggested that PAK6 expression was associated with poor prognosis (P < 0.001). Multivariate analysis indicated that PAK6 and Ki-67 protein expressions were independent prognostic markers for HCC (P = 0.0245 and 0.0331, respectively). ConclusionsOur results suggest that PAK6 overexpression is involved in the pathogenesis of HCC; it may be an independent poor prognostic factor for HCC.

Laryngeal synovial cell sarcoma in an 11 year old boy: Challenges of management and rehabilitation

Despite the fact that vocal nodules are the most common cause of chronic dysphonia in children, uncertainty and lack of consensus complicates practically every diagnostic and management decision. Selecting an optimal staging system is fundamental to understanding a disease process, mandatory for uniform reporting, and crucial to predicting natural history and treatment outcomes. The ideal prognostic model for vocal nodules is under intense debate. The purpose of this study was to analyze the predictive power of vocal nodule grade to severity of voice metrics in children.Seventy-nine patients diagnosed with vocal cord nodules between 2006 and 2012 were drawn from UPMC Children's Hospital of Pittsburgh Voice, Resonance and Swallowing Center Research Registry. Subject age at time of diagnosis, nodule grade, relevant co-morbidities, scores on The Consensus Auditory-Perceptual Evaluation of Voice (CAPE-V), parent-reported Pediatric Voice Handicap Index (pVHI), the phonotraumatic behaviors profile, habitual speaking pitch fundamental frequencies, pitch range, volume intensity, and s/z ratio were recorded and compiled into a de-identified database for analysis.Based on the Kruskal-Wallis H Test, there was no statistically significant correlation between nodule grade and total pitch range (p = .21), s/z ratio (p = .50), volume intensity (p = .33), overall CAPE-V Scores (p = .15), or pVHI Scores (p = .29). Chi-squared tests also revealed no significant associations between nodule grade and abnormality in habitual speaking pitch (p = .14 for fundamental frequency while sustaining a vowel sound, p = .37 for fundamental frequency while speaking structured tasks i.e. counting, or p = .76 while speaking in conversation).The current “gold-standard” for grading vocal nodule size suggests that the nodules themselves are not driving the standard dysphonic metrics that are most commonly collected and monitored in such children. This outcome is consistent with other studies reporting similar findings and was expected based on the inconsistencies in the reported literature to date. By extension, the conventional wisdom of avoiding surgical treatment of vocal nodules in children seems prudent as there is little evidence to suggest that the nodules themselves are “driving” the severity of the dysphonia. Ultimately identifying the true “drivers” of dysphonia in children will suggest alternative therapies that are more specific and directed to the pathophysiology. Most pediatric voice care professionals will welcome such discoveries as those in the front line of patient care are often rendered helpless and frustrated.

Geophysical and Geological Exploration of Cobalt-rich Ferromanganese Crusts: An Attempt of Small-Scale Mapping on a Micronesian Seamount

Ferromanganese crusts in the Pacific Ocean are potential economic resources of cobalt, nickel and platinum. Previous shipboard geological and geophysical exploration has been directed towards innovation in effective methods of mapping the abundance and grade of manganese nodules on the seafloor for evaluation and mine site selection. However, any simple techniques have not been valid for complicated and variable nature of the crusts and topography. This study attempts to establish a distribution pattern of ferromanganese deposits on a Micronesian seamount using conventional narrow-beam and SSS mapping, dredge sampling Cand TV/camera monitoring with a geological interpretation. We tried to correlate acoustic remote sensing data with the surface geology, and decipher the regional-scale distribution of crusts in relation to large-scale mass wasting that took place in the early Miocene or before. The general distribution pattern of crusts over the surface of the seamount indicates that only about 40% of the apparent “acoustic outcrop” represents actual ferromanganese crust coverage. The combined method outlined here is the most useful in evaluating ferromanganese deposits, prior to possible hi-tech fine-scale mapping using submersibles, ROV and AUV.

A GENETIC ALGORITHMS BASED MULTI-OBJECTIVE OPTIMIZATION APPROACH APPLIED TO A HYDROMETALLURGICAL CIRCUIT FOR OCEAN NODULES

Several hydrometallurgical processes have been studied for the extraction of metals from lean ores utilizing various flow sheet options. Of particular significance is the grade of the ore being treated, the energy consumed and associated costs, options for byproduct recovery, and the relative price of the products. A process scheme needs to be optimized for simultaneously maximizing metal throughput and minimizing the direct operating costs incurred within constraints set for the operating variables. This leads to a multi-objective optimization problem. The range of input grades for raw material, which a flowsheet can handle, needs to be worked out based on an optimization exercise. A lean manganese-bearing resource such as polymetallic sea nodules has been chosen in this article for the development of an optimization approach based on which the input raw nodules grades are to be treated by a particular flowsheet. Only the chemical consumption costs have been adopted in this article as a measure of direct operating costs. A linear simulation model for the flowsheet has been developed, keeping a set of design parameters constant. The solutions generated by using a sequential modular approach become inputs to an optimization procedure based on a multi-objective genetic algorithm belonging to the differential evolution family. The variables considered in the optimization task are the grade of nodules and reactivity of different species inside the reactor. A nickel equivalent (t/h function) has been suggested as a measure of productivity, as it indirectly enhances the input manganese ore grade through a price ratio effect. This productivity function was maximized with the simultaneous minimization of direct chemical costs. Pareto optimal solutions were generated with grades of nodules and reactivity in the leach reactor as decision variables. The effect of the price ratio on the Pareto optimal solutions was also investigated. The various cases investigated clarifies the methodology for choosing an appropriate ore grade range for a given process flowsheet. Appropriate decisions regarding the nature of raw material to be used for a given flowsheet are then found on the basis of the Pareto optimal solutions.

Relationship between voice quality and vocal nodule size

To determine the effect of vocal nodule size on voice in pediatric patients. Vocal nodules were graded according to a validated grading scale by three pediatric otolaryngologists. Patients evaluated from 2003 to 2007 with a diagnosis of vocal nodules were included. Forty patients (21 female) with a mean age of 7.5 years were identified. Vocal nodules were rated as grade 1 (17 patients), grade 2 (15 patients), and grade 3 (8 patients). Pitch range was reduced in patients with larger nodules (P = 0.001). There was no statistical association between nodule grade and fundamental frequency abnormality, perturbation, shimmer, decreased respiratory support, air loss, or significant muscle tension. Voice characteristics in patients with vocal nodules were evaluated. Other than pitch reduction, objective and subjective voice measurements are not statistically different in varying vocal nodule sizes; however, many of the measures did show a trend towards significance. Vocal rehabilitation is complex in children with nodules and may not directly correlate with vocal nodule size.

Distribution pattern and morphochemical relationships of manganese nodules from the Central Indian Basin

In the Central Indian Basin manganese nodule abundance was variable in all sediment types. Mean abundance varied from 1.5 in calcareous ooze to 10.2 kg/m2 in terrigenous-siliceous ooze sediments. Nodule grade and growth rates are positively correlated only up to 10 mm/My (million years), and grade shows no distinct relationship with abundance. Relationships between the morphochemical characteristics of the nodules and host sediment types are subtle. Both hydrogenetic and diagenetic nodules (with smooth and rough surfaces respectively) occur on almost all sediments, but in variable proportions. Thus, the overall distribution pattern shows that small nodules ( 4-cm diameters) of higher grade (average value Ni+Cu+Co=1.80%) with rough surfaces are more prevalent on siliceous ooze, siliceous ooze-red clay, and calcareous ooze-red clay transition-zone sediments. This implies an enhanced supply of trace metals from pore waters to rough-surface nodules during early diagenesis.

Radiographic and pathologic correlation of coal workers' pneumoconiosis.

The relationships between chest radiographs (CXR) and corresponding pathology were investigated in 430 autopsied coal miners from West Virginia. Whole-lung sections were reviewed and graded on four-point severity scales for the following lesions of coal workers' pneumoconiosis (CWP): macules, micro- and macronodules (small and large fibrotic nodules), and progressive massive fibrosis (PMF). Antemortem CXR were classified by three B readers using the 1971 International Labor Office (ILO) U/C classification (6). On pathologic examination, 96% of miners had macules, 70% micronodules, 45% macronodules, 15% silicosis, and 28% PMF. By CXR, 69% of the miners had small, rounded opacity profusions of category > or = 0/1. Data analysis revealed increasing odds that small opacities of category > or = 0/1 would be detected with increasing grade of nodules. Profusion category 0/0 was often reported for cases with macules of mild to moderate grade and mild levels of micronodules. Overall, q-type opacities were associated with macules and micronodules, whereas the large r-type opacities were associated with macronodules. By CXR, large opacities showed good correlation with pathologic PMF. However, about one-third of cases identified as having large opacities by CXR were not substantiated as PMF by pathology. One-fourth of these cases could be explained by lung lesions such as Caplan's nodules, tuberculosis scars, and tumors. Similarly, 22% of cases classified as PMF on pathology had no large opacities by CXR. In half of these cases, the radiologists had noted other abnormalities (cancer, tuberculosis) by CXR as large opacities. Overall, the study showed good agreement (Somer's d = 0.64) between the predicted probabilities and observed responses of a profusion category > or = 0/1 for pathologic CWP lesions. However, the study also showed that CXR were insensitive for detecting minimal CWP lesions, and were unreliable indicators in the presence of concomitant pulmonary pathology.

肝細胞癌切除後再発腫ようの経皮的細針生検による異時性多中心性発癌に関する検討

肝細胞癌切除後再発腫ようの経皮的細針生検による異時性多中心性発癌に関する検討

Metal chemistry of manganese nodules from the Cape Leeuwin field, southeast Indian Ocean

Manganese nodules from 36 stations in the Cape Leeuwin field were analyzed for Mn, Fe, Ni, Cu and Co and the results were combined with earlier work to demonstrate quantitative and geographic variations. Nodules in this field are moderately enriched in Ni, moderately depleted in Cu, and contain intermediate values of Co. The sum of Ni + Cu vs. Mn Fe plots along a hyperbolic regression line derived from nodules of the southeastern Pacific, suggesting that this relationship has general applicability. Regional variations in nodule grade (Ni + Cu + Co) assist in defining pathways of Antarctic Bottom Water between the Southeast Indian Ridge and the Wharton basin.

Polymetallic nodules resources and reserves in the North Pacific from the data collected by AFERNOD

Abstract Many evaluations of the resources of polymetallic nodules have been published in the past, but few were established from the data acquired recently by the mining companies. As it was emphasized recently by the SIO group that devotes a lot of research effort in compiling the available data on manganese nodule: “The lack of abundance measurements, particularly in those areas where we have a good idea of nodule grade portends a doubtful future for meaningful resources projections” (Frazer, 1979). In this paper we want to discuss the data, already published and newly released, and to analyse their significance in matter of nodules resources and reserves.

Chemical and mineralogical investigations on deep sea manganese nodules from the Southern Ocean

Deep sea manganese nodules from the Southern Ocean have been studied using chemical analysis, X-ray diffraction, optical mineragraphic and electron probe microanalysis techniques. The nodules were lower in manganese, iron and associated elements than the average grade of manganese nodules from other localities. A number of chemical relationships have been observed. Nickel, copper, cobalt, barium, zinc, molybdenum, strontium, sulphur and phosphorus are associated with the manganese rich phases and titanium with the iron rich phases. X-ray diffraction analysis and electron probe microanalysis results indicate that the manganese phases are similar to the disordered δ-MnO2 and “manganite” phases reported by other workers.