Presence Of Air Bronchograms Research Articles

Is 18F-fluorodeoxyglucose PET recommended for small lung nodules? CT findings of 18F-fluorodeoxyglucose non-avid lung cancer.

To determine the image characteristics associated with low 18F-FDG (18F-fluorodeoxyglucose) avidity among 8-15 mm solid lung cancer. Patients satisfying the following criteria were included: underwent surgery between January 2014 and December 2019 for lung cancer, presented 8-15 mm nodule without measurable ground glass component on preoperative CT, and underwent 18F-FDG PET before resection. Image characteristics, including air bronchogram, concave shape, pleural attachment, and background emphysema, were evaluated by two board-certified radiologists. The Mann-Whitney U test was used to compare maximum standardized uptake (SUVmax) values from 18F-FDG PET images. The analysis included 235 patients. The SUVmax values of lesions with air bronchogram and concave shape were significantly lower than the SUVmax values of lesions without these features (median: 1.55 vs 2.56 and 1.66 vs 2.45, both P < .001), whereas lesions arising from emphysematous lungs had significantly higher SUVmax values than lesions arising from non-emphysematous lungs (2.90 vs 1.69, P < .001). No significant differences were detected between lesions attached and not attached to pleura. The interobserver agreement was almost perfect for air bronchograms and background emphysema (κ = 0.882 and 0.927, respectively), and 89.7% of lesions with air bronchograms and arising from non-emphysematous lungs showed SUVmax values below 2.5. Among 8-15 mm solid lung cancer, the presence of air bronchograms and concave shape and the absence of background emphysema were associated with low 18F-FDG accumulation. 18F-FDG PET can be misleading in differentiating certain type of small solid lung cancer.

Investigation of Childhood Pneumonia With Thoracic Ultrasound: A Comparison Between X-ray and Ultrasound.

Childhood pneumonia is a common entity, and chest x-rays are widely used as an initial diagnostic step. To avoid radiation exposure in the pediatric age group, we assessed whether the diagnostic accuracy of ultrasound (US) imaging is sufficient in the diagnosis. One hundred thirty-three children with pneumonia (72 girls/61 boys) were participated to study between 2019 and 2021. All participants had a chest x-ray. Radiologists who perform the US scans and interpret the x-rays were blinded to each other. A comparative analysis was also done to assess US findings on pneumonia for different age groups. We compare the diagnostic accuracy of US and x-rays by McNemar test and receiver operating characteristic curves. Intraclass correlation coefficient values were calculated for the assessment of interobserver agreement of x-ray evaluation. The participants' ages ranged from 1 month to 17 years and 8 months with a median age of 24 months (Q 1 : 8 and Q 3 : 66 months). Hospital stay lengths were longer, consolidation depths were greater, and presence of air bronchogram or pleural effusion was more frequent in school-age children. The proportion of consolidation seen on chest x-ray and transthoracic US scan was significantly different ( P < 0.001). The area under the curve was greater in the US than in the chest x-ray (area under the curve, 0.94 and 0.76 respectively). There was a good agreement between the 2 interpreters on chest x-ray assessment ( κ = 0.661). The thoracic US can be used as a safe and efficient imaging tool in the diagnosis of pediatric pneumonia.

Post-percutaneous core needle biopsy sputum cytology: diagnostic value and factors for positive prediction in diagnosing malignancy

Background: This study evaluated the diagnostic yield and positive predictive factors of post-percutaneous core needle biopsy (PCNB) sputum cytology in diagnosing malignancy.Methods: This retrospective study included patients who underwent PCNB at a single center from January 2014 to March 2022. Patient demographics, lung lesion characteristics on computed tomography, underlying lung disease, post-PCNB complications, histopathologic results of PCNB, post-PCNB sputum specimens, and final diagnoses were reviewed. The diagnostic yields and related factors were analyzed.Results: Overall, 177 consecutive patients with sputum specimens obtained after PCNB for intrapulmonary lesions were enrolled. Among them, 152 patients had a final diagnosis of malignancy. Diagnostic sputum specimens with atypical or malignant cells were obtained in 12 patients. The sensitivity, specificity, accuracy, positive predictive value, and negative predictive value of sputum cytology were 7.89%, 100%, 20.90%, 100%, and 15.15%, respectively. Lesion size, air-bronchogram, lesion multiplicity, and the cell type of squamous cell and adenocarcinoma differed significantly between the groups with diagnostic versus non-diagnostic sputum (p&lt;0.05). The lesion size (odds ratio [OR], 1.035; 95% confidence interval [CI], 1.008–1.064; p=0.013), presence of air-bronchogram (OR, 23.485; 95% CI, 2.532–217.316; p=0.005), and squamous cell carcinoma (OR, 7.397; 95% CI, 1.773–30.865; p=0.006) were significantly associated with a diagnostic sputum specimen post-PCNB.Conclusions: Although post-PCNB sputum cytology had low sensitivity in diagnosing lung cancer, it showed diagnostic results in some peripheral lung cancer patients who have squamous cell types, relatively large tumors, and air-bronchograms in the lesions.

Ultrasound-guided lung biopsy for small (≤2 cm) subpleural lung lesions: comparison of diagnostic yield and safety with larger lesions.

Ultrasound (US)-guided percutaneous core needle biopsy (PCNB) has been used to diagnose subpleural lung lesions with high diagnostic performance and acceptable complication rates. However, with regard to the role of US-guided needle biopsy for the diagnosis of small (≤2 cm) subpleural lesions, limited information is available. From April 2011 to October 2021, a total of 572 US-guided PCNBs in 572 patients were retrospectively reviewed. The lesion size, pleural contact length (PCL), lesion location, and operator's experience were analyzed. Computed tomography features including peri-lesional emphysema, air-bronchogram, and cavitary change were also included in image analysis. The patients were divided into three groups according to lesion size (lesions ≤2 cm vs. 2 cm< lesions ≤5 cm vs. lesions >5 cm). The sample adequacy, diagnostic success rate, diagnostic accuracy, and complication rate was calculated. For statistical analysis, one-way ANOVA, Kruskal-Wallis test, or the chi-square test were used. The overall sample adequacy, diagnostic success rate, and diagnostic accuracy were 96.2%, 82.9%, and 90.4%, respectively. In the subgroup analysis, sample adequacy (93.1% vs. 96.1% vs. 96.9%, P=0.307), diagnostic success rate (75.0% vs. 81.6% vs. 85.7%, P=0.079), and diagnostic accuracy (84.7% vs. 90.8% vs. 90.5%, P=0.301) were not significantly different. Operator's experience (OR, 0.64; 95% CI: 0.49-0.80; P<0.001), lesion size (OR, 0.68; 95% CI: 0.54-0.83; P<0.001), PCL (OR, 0.68; 95% CI: 0.52-0.84; P=0.001), and presence of air-bronchogram (OR, 14.36; 95% CI: 4.18-48.53; P<0.001) were independently associated with complication rate. US-guided PCNB performed by an experienced radiologist could be an effective and safe diagnostic approach for subpleural lesions, even in small lesions.

CT features of rounded atelectasis in chronic inflammatory pleural effusions in cats and dogs.

Rounded atelectasis is well described in human medicine as focal lung deformation and collapse secondary to inflammatory pleural effusions and pleuritis. Specific CT features (round to ovoid soft tissue pulmonary attenuations, creation of an acute angle with the adjoining visceral pleura, and the presence of perinodular comet tail signs) support the diagnosis of rounded atelectasis in humans so that further diagnostic workup is not necessary in defining the nodules. In this retrospective case series, we described the CT characteristics of rounded atelectasis in eight cats and three dogs diagnosed with restrictive pleuritis secondary to either a chylothorax or pyothorax. Thirty-six soft tissue attenuating pulmonary nodular lesions were identified on CT. Comet tail signs, consisting of bundles of bronchi and vessels coalescing into the pulmonary nodules, were associated with 92% of the nodules (33/36), and 92% of the nodules abutted and created an acute angle with the pleura (33/36). Other prevalent features included location in gravity-dependent regions of the lung lobes (33/36, 92%), blurred hilar margins with sharper pleural margins of the nodules (33/36, 92%), presence of air bronchograms (30/36, 83%), homogeneous contrast-enhancement (23/36, 64%), and volume loss of the affected lung lobe (22/36, 61%). Pulmonary malignant neoplasms were not found cytologically (6/11 patients) or histologically (5/11 patients). To avoid a misdiagnosis of neoplasia, veterinary radiologists should be aware of the CT features of rounded atelectasis and consider it as a differential for pulmonary nodular lesions in patients with concurrent inflammatory pleural effusion and pleuritis.

Diagnostic value of dual-layer spectral detector CT in differentiating lung adenocarcinoma from squamous cell carcinoma.

The pathological type of non-small cell lung cancer is considered to be an important factor affecting the treatment and prognosis. The purpose of this study was to investigate the diagnostic value of spectral parameters of dual-layer spectral detector computed tomography (DLCT) in determining efficacy to distinguish adenocarcinoma (AC) and squamous cell carcinoma (SC), and their combined diagnostic efficacy was also analyzed. This is a single-center prospective study, and we collected 70 patients with lung SC and 127 patients with lung AC confirmed by histopathological examination. Morphological parameters, plain scan CT value, biphasic enhanced CT value, and spectral parameters were calculated. The diagnostic efficiency of morphological parameters, spectral parameters, and spectral parameters combined with morphological parameters was obtained by statistical analysis. In univariate analysis, seven morphological CT features differed significantly between SC and AC: tumor location (distribution), lobulation, spicule, air bronchogram, vacuole sign, lung atelectasis and/or obstructive pneumonia, and vascular involvement (all p < 0.05). In the arterial phase and the venous phase, the spectral parameters of AC were higher than those of SC (AP-Zeff: 8.07 ± 0.23 vs. 7.85 ± 0.16; AP-ID: 1.41 ± 0.47 vs. 0.94 ± 0.28; AP-NID: 0.13 ± 0.04 vs. 0.09 ± 0.03; AP-λ: 3.42 ± 1.10 vs. 2.33 ± 0.96; VP-Zeff: 8.26 ± 0.23 vs. 7.96 ± 0.16; VP-ID: 1.18 ± 0.51 vs. 1.16 ± 0.30; VP-NID: 0.39 ± 0.13 vs. 0.29 ± 0.08; VP-λ: 4.42 ± 1.28 vs. 2.85 ± 0.72; p < 0.001). When conducting multivariate analysis combining CT features and DLCT parameters with the best diagnostic efficacy, the independent predictors of AC were distribution on peripheral (OR, 4.370; 95% CI, 1.485-12.859; p = 0.007), presence of air bronchogram (OR, 5.339; 95% CI, 1.729-16.484; p = 0.004), and presence of vacuole sign ( OR, 7.330; 95% CI, 1.030-52.184; p = 0.047). Receiver operating characteristic curves of the SC and AC showed that VP-λ had the best diagnostic performance, with an area under the curve (AUC) of 0.864 and sensitivity and specificity rates of 85.8% and 74.3%, respectively; the AUC was increased to 0.946 when morphological parameters were combined, and sensitivity and specificity rates were 89.8% and 87.1%, respectively. The quantitative parameters of the DLCT spectrum are of great value in the diagnosis of SC and AC, and the combination of morphological parameters and spectral parameters is helpful to distinguish SC from AC.

Solitary Pulmonary Capillary Hemangioma: CT and PET-CT Features with Clinicopathologic Correlation.

The aim of this study was to evaluate the CT and PET-CT features of solitary pulmonary capillary hemangioma (SPCH) with clinicopathologic correlations. This retrospective study included 17 patients with histologically proven SPCH from four tertiary institutions. The clinical, pathological and imaging findings of SPCH were reviewed. The CT features assessed included lesion location, size, density, contour, margin, enhancement, presence of air bronchogram, perivascular lucency and pleural retraction, and 18F-fluorodeoxyglucose uptake on PET-CT. Changes in the size during the follow-up period were also evaluated. Imaging features were correlated with the clinicopathologic findings. The mean age of the patients was 47 years (range 30-60 years). All SPCHs were incidentally detected during screening CT examinations (n = 13, 76%) or during cancer work-up (n = 4, 24%). Most SPCHs appeared as part-solid nodules (n = 15, 88%), the remaining appeared as a pure ground-glass nodule or a pure solid nodule, respectively. Most had smooth contours (n = 16, 94%), while one had a lobulated contour. Nine SPCHs (53%) showed ill-defined margins. Air bronchogram was present in ten (59%) SPCHs, and perivascular lucency in two (12%). All SPCHs exhibited hypoattenuation on contrast-enhanced CT and hypometabolism on PET-CT. During the follow-up period (mean 14.8 ± 17.7 months), the lesions showed no change in size or density in ten SPCHs (59%), decreased or fluctuation in size and density in three (18%). SPCH is often incidentally detected in young and middle-aged adults, commonly as an ill-defined part-solid nodule that may accompany air bronchogram, perivascular lucency, and fluctuation in size or density on CT and hypometabolism on PET-CT.

Computed Tomography Imaging Characteristics: Potential Indicators of Epidermal Growth Factor Receptor Mutation in Lung Adenocarcinoma.

The purpose of this study was to investigate the correlation between computed tomography imaging characteristics in lung adenocarcinoma and epidermal growth factor receptor (EGFR) mutations. A total of 124 patients with lung adenocarcinoma and known EGFR mutation status were collected in this retrospective study. Computed tomography quantitative parameters of each tumor, including total volume, total surface, surface-to-volume ratio (SVR), average diameter, maximum diameter, and average density, were determined using computer-aided detection software. The correlation between the EGFR mutation status and imaging characteristics was assessed. The predictive value of these imaging characteristics for EGFR mutation was calculated using the area under the receiver operating characteristic curve. Fifty-eight of 124 patients showed EGFR mutations. Patients who are female (P < 0.001) and nonsmokers (P < 0.001) and those with serum carcinoembryonic antigen (CEA) level of ≥5 (P = 0.035) were likely to have EGFR mutation. Computed tomography features including air bronchogram (P = 0.035), absence of cavitation (P = 0.010), and absence of pulmonary emphysema (P = 0.002) and quantitative parameters, such as smaller total surface (P = 0.002), smaller total volume (P = 0.001), higher SVR (P = 0.003), and smaller average diameter (P = 0.001), were associated with EGFR mutation. Logistic regression analysis revealed that the most significant independent prognostic factors of EGFR mutation for the model were nonsmoking (P = 0.035), CEA level of ≥5 (P = 0.004), presence of air bronchogram (P = 0.040), absence of cavitation (P = 0.021), and high SVR (P = 0.014). The area under the receiver operating characteristic curve, sensitivity, and specificity of the model for predicting EGFR mutation were 0.827, 75.8%, and 82.8%, respectively. EGFR-mutated adenocarcinoma showed significantly increased CEA level, presence of air bronchogram, absence of cavitation, and higher quantitative parameter SVR than those with wild-type EGFR.

P68.01 Qualitative Computed Tomographic Features Predict Epidermal Growth Factor Receptor Mutations in Advanced Lung Adenocarcinoma

Introduction: Current guidelines recommend reflex testing for EGFR mutations in patients with advanced lung adenocarcinoma. Although tissue biopsy is considered the “gold standard” for EGFR mutation testing, it may not always be feasible in a small group of patients. Hence, this study aims to determine the computed tomography (CT) features that may predict the presence of common sensitising EGFR mutation in newly diagnosed advanced lung adenocarcinoma patients. Methods: 182 diagnostic contrast enhanced CT-images of newly diagnosed advanced lung adenocarcinoma patients who attended University Malaya Medical Center from 2010 to 2014 were analysed. For EGFR mutation testing, tissue biopsy specimens of all patients were tested for exon 19 deletion and exon 21 L858R point mutation. Results: Of the 182 patients, 158 patients with measurable primary tumour, were included in the analysis. 67 (42.4%) patients had common sensitising EGFR mutations, of which 43 (64.1%) were exon 19 deletion and 24 (35.9%) were exon 21 L858R point mutation. CT features of these patients are stated in Table 1. Common sensitising EGFR mutations were significantly more common in primary tumours with round contour (p ¼ 0.029), homogenous enhancement (p ¼ 0.029) and presence of air-bronchogram (p ¼ 0.029). On the other hand, presence of emphysema (p ¼ 0.005) and intrathoracic lymph nodes enlargement (p ¼ 0.001) were significantly against the presence of common sensitising EGFR mutations. These findings were further supported by the multivariate analysis: round contour [odd ratio (OR): 13.6, 95% confidence interval (CI): 1.40 - 13.2, p ¼ 0.024], homogenous enhancement (OR: 2.5, 95% CI: 1.00 - 6.47, p ¼ 0.049), presence of air bronchogram (OR: 2.7, 95% CI: 1.28 e 5.53, p ¼ 0.009) and intrathoracic lymph nodes enlargement (OR: 0.2, 95% CI: 0.05 - 0.52, p ¼ 0.002). None of the CT features could differentiate exon 19 deletion from exon 21 L858R point mutation. Conclusion: Tumours with round contour, homogenous enhancement and air bronchogram as well as absence of intrathoracic lymph nodes enlargement were independent predictors of the presence of common sensitising EGFR mutations. This information is helpful to clinicians in selecting best empirical treatment for patients who are not eligible for tissue biopsy and in those who need urgent treatment because of rapid clinical deterioration.

Inter-Reader Variability of Volumetric Subsolid Pulmonary Nodule Radiomic Features

To evaluate the inter-observer consistency for subsolid pulmonary nodule radiomic features. Subsolid nodules were selected by reviewing radiology reports of CT examinations performed December 1, 2015 to April 1, 2016. Patients with CTs at two time points were included in this study. There were 55 patients with subsolid nodules, of whom 14 had two nodules. Of 69 subsolid nodules, 66 were persistent at the second time point, yielding 135 lesions for segmentation. Two thoracic radiologists and an imaging fellow segmented the lesions using a semi-automated volumetry algorithm (Syngo.via Vb20, Siemens). Coefficient of variation (CV) was used to assess consistency of 91 quantitative measures extracted from the subsolid nodule segmentations, including first and higher order texture features. The accuracy of segmentation was visually graded by an experienced thoracic radiologist. Influencing factors on radiomic feature consistency and segmentation accuracy were assessed using generalized estimating equation analyses and the Exact Mann-Whitney test. Mean patient age was 71 (38-93 years), with 39 women and 16 men. Mean nodule volume was 1.39mL, range .03-48.2mL, for 135 nodules. Several radiomic features showed high inter-reader consistency (CV<5%), including entropy, uniformity, sphericity, and spherical disproportion. Descriptors such as surface area and energy had low consistency across inter-reader segmentations (CV>10%). Nodule percent solid component and attenuation influenced inter-reader variability of some radiomic features. The presence of contrast did not significantly affect the consistency of subsolid nodule radiomic features. Near perfect segmentation, within 5% of actual nodule size, was achieved in 68% of segmentations, and very good segmentation, within 25% of actual nodule size, in 94%. Morphologic features including nodule margin and shape (each p <0.01), and presence of air bronchograms (p = 0.004), bubble lucencies (p = 0.02) and broad pleural contact (p < 0.01) significantly affected the probability of near perfect segmentation. Stroke angle (p = 0.001) and length (p < 0.001) also significantly influenced probability of near perfect segmentation. The inter-observer consistency of radiomic features for subsolid pulmonary nodules varies, with high consistency for several features, including sphericity, spherical disproportion, and first and higher order entropy, and normalized non-uniformity. Nodule morphology influences the consistency of subsolid nodule radiomic features, and the accuracy of subsolid nodule segmentation.

Quantitative Evaluation of COVID-19 Pneumonia Lung Extension by Specific Software and Correlation with Patient Clinical Outcome.

Lung infection named as COVID-19 is an infectious disease caused by the most recently discovered coronavirus 2 (SARS-CoV-2). CT (computed tomography) has been shown to have good sensitivity in comparison with RT-PCR, particularly in early stages. However, CT findings appear to not always be related to a certain clinical severity. The aim of this study is to evaluate a correlation between the percentage of lung parenchyma volume involved with COVID-19 infection (compared to the total lung volume) at baseline diagnosis and correlated to the patient’s clinical course (need for ventilator assistance and or death). All patients with suspected COVID-19 lung disease referred to our imaging department for Chest CT from 24 February to 6 April 2020were included in the study. Specific CT features were assessed including the amount of high attenuation areas (HAA) related to lung infection. HAA, defined as the percentage of lung parenchyma above a predefined threshold of −650 (HAA%, HAA/total lung volume), was automatically calculated using a dedicated segmentation software. Lung volumes and CT findings were correlated with patient’s clinical course. Logistic regressions were performed to assess the predictive value of clinical, inflammatory and CT parameters for the defined outcome. In the overall population we found an average infected lung volume of 31.4 ± 26.3% while in the subgroup of patients who needed ventilator assistance and who died as well as the patients who died without receiving ventilator assistance the volume of infected lung was significantly higher 41.4 ± 28.5 and 72.7 ± 36.2 (p < 0.001). In logistic regression analysis best predictors for ventilation and death were the presence of air bronchogram (p = 0.006), crazy paving (p = 0.007), peripheral distribution (p < 0.001), age (p = 0.002), fever at admission (p = 0.007), dyspnea (p = 0.002) and cardiovascular comorbidities (p < 0.001). In multivariable analysis, quantitative CT parameters and features added incremental predictive value beyond a model with only clinical parameters (area under the curve, 0.78 vs. 0.74, p = 0.02). Our study demonstrates that quantitative evaluation of lung volume involved by COVID-19 pneumonia helps to predict patient’s clinical course.

Infliximab-associated pulmonary tuberculosis

Tumor necrosis factor alpha antagonist drug therapy has been beneficial in the treatment of several diseases such as connective tissue and inflammatory bowel diseases, but it is not without risks. The main complications of these immunosuppressive drugs are infections, and pulmonary tuberculosis is one of the main conditions, which can be observed in patients with this type of treatment. A 31-year-old woman, treated at the Hermanos Ameijeiras Clinical Surgical Hospital, Havana, Cuba, with a history of ulcerative colitis, who has been receiving infliximab therapy for 3 months, presented. He went to the hospital for referring 4 days prior to admission, a fever of 390 C twice a day, accompanied by headache, loss of appetite and pain in the perineal region. A chest X-ray was performed, which described heterogeneous radiopacity that goes from the upper horn of the right hilum to axillary planes, in the chest axial tomography they report consolidation in the anterior segment of the right upper lobe with the presence of air bronchogram and in the bronchial lavage microbiological for acid-fast bacilli coding 8, positive for mycobacterium tuberculosis was reported. Accurate diagnosis of tuberculosis related to the use of tumor necrosis factor alpha antagonist drugs requires a high index of suspicion and detailed investigation. There is a high degree of diagnostic complexity, due to the existence of a wide clinical spectrum and the need to exclude other diseases.

Lobar Pneumonia in a Farmer Responded to Anti-melioidosis Antibiotics

A 46-year-old male, farmer, with no prior medical illness presented with a one-month history of intermittent right-sided pleuritic chest pain and productive cough. He complained of fever and breathlessness 3 days before current presentation to the district hospital. He denied any haemoptysis, night sweats, or contact with pulmonary tuberculosis. On examination, the vital signs were normal and lung auscultation revealed bronchial breath sounds and crepitation over the right upper zone. Chest radiograph demonstrated a right upper lobe consolidation with presence of air bronchogram and abdominal ultrasonography was normal. He was admitted for intravenous antibiotic therapy for a presumptive diagnosis of community-acquired pneumonia. He was initially treated with intravenous amoxicillin-clavulanic acid 1.2 g every 8 hours. Differential diagnosis of pulmonary tuberculosis was also considered but later ruled out as the sputum for direct smear microscopy, GenXpert and culture for Mycobacterium tuberculosis were negative. The melioidosis IgM (ELISA), multiple blood and sputum cultures were also negative. A PCR-based confirmatory test for melioidosis was however not available at our setting. In the ward, he continued to have persistent fever and repeated chest radiograph after 1 week of antibiotic showed worsening of right upper lobe consolidation. At this point in time, melioidosis was suspected due to the risk factor of farming. Antibiotic was then changed to intravenous ceftazidime 2 g every 6 hours. The patient responded positively as evidenced by the resolution of fever and respiratory symptoms, and repeated chest radiograph showed improving consolidation at 2 weeks. He was discharged after completing a 2-week course of intravenous ceftazidime, and simultaneously started on oral trimethoprim-sulfamethoxazole as eradication therapy. Upon review in the outpatient clinic 6 weeks later, chest radiograph showed marked improvement with minimal residual right upper lobe consolidation. He was clinically well and did not show any symptoms of relapse. He was planned for eradication therapy of 20 weeks’ duration.

The application of conventional us and transthoracic ultrasound elastography in evaluating peripheral pulmonary lesions.

The aim of the present study was to evaluate the diagnostic value of ultrasound (US) elastography in differentiating between benign and malignant peripheral lung lesions (PLLs). This retrospective study included 91 consecutive patients with 91 PLLs. Conventional US, strain elastography (SE), acoustic radiation force impulse imaging (ARFIimaging) and point share wave elastography (p-SWE) were performed. All of the pathological results were confirmed by US-guided biopsies or surgeries. There were 36 benign PLLs and 55 malignant PLLs on pathology. For conventional US, a lesion diameter ≥5 cm, irregular contour, presence of air bronchogram and non-abundant vascularity were predictive factors of malignancy (P<0.05). SE scores were observed to be invalid in differentiating between malignant and benign PLLs (P=0.542). For ARFIimaging scores, an elasticity score of 3 or greater was predictive of malignancy, with a sensitivity of 83.6% (46/55) and a specificity of 52.8% (19/36). For p-SWE, the share wave velocity of malignant PLLs was higher than benign ones (2.47±0.92 vs. 1.85±0.92 m/sec; P=0.0022). When 1.951 m/sec was selected as the cut-off value, a sensitivity of 70.9% (39/55) and a specificity of 69.4% (25/36) were obtained. Thus, US, particularly US elastography, is helpful in distinguishing malignant PLLs from benign PLLs.

High-resolution computed tomography features and CT-guided microcoil localization of subcentimeter pulmonary ground-glass opacities: radiological processing prior to video-assisted thoracoscopic surgery.

With the rapid development of high-resolution computed tomography (HRCT), low-dose CT scanning and video-assisted thoracoscopic surgery (VATS), smaller pulmonary nodules can be detected. Subcentimeter ground-glass opacities (GGOs) are extremely difficult to diagnose and accurately locate during VATS and in surgically resected specimens. From September 2013 to September 2017, 42 subcentimeter GGO lesions (≤1 cm) in 31 patients who underwent CT-guided microcoil insertion followed by VATS resection were included. All HRCT images were assessed by two experienced radiologists, and CT-guided microcoil localization procedures were performed by two experienced interventional radiologists. A total of 42 subcentimeter GGOs included 28 malignancies (66.7%) and 14 benign lesions (33.3%). The diameter of malignant GGOs (8.52±1.46 mm) was significantly larger than that of benign lesions (7.04±1.52 mm) (P<0.05). Seven patients had more than one GGO nodule. There were no significant differences in the location, composition, shape, margins, presence of air bronchograms, presence of the pleural indentation sign and presence of the vascular convergence sign between benign and malignant GGOs (P>0.05). All the localization procedures were performed successfully. A small pneumothorax occurred in 9 patients (21.4%), and minor hemorrhage in the lung parenchyma occurred in 8 patients (19.0%). All GGOs were easily identified during VATS and were definitively diagnosed. Common HRCT features cannot be used as criteria for the differential diagnosis of subcentimeter benign and malignant pulmonary GGOs. CT-guided microcoil marking of these lesions prior to VATS is a feasible, safe, and effective procedure for the localization of subcentimeter pulmonary GGOs.

Radiological Features of Programmed Cell Death-Ligand 2-positive Lung Adenocarcinoma: A Single-institution Retrospective Study.

Programmed cell death-ligand 1 and 2 (PD-L1 and PD-L2) are ligands of the programmed cell death-1 (PD1) receptor. PD1/PD-L1 inhibitors have shown clinical efficacy in non-small cell lung cancer (NSCLC). However, relatively little is known about the expression of PD-L2, or its association with the clinicopathological features of NSCLC. Here, the radiological features of PD-L2-positive lung adenocarcinoma were evaluated. PD-L1 and PD-L2 expression were evaluated by immunohistochemical staining of surgically-resected specimens from 393 patients with primary lung adenocarcinoma who underwent preoperative thin-section computed tomography (CT), 222 of whom also underwent 18F-fluorodeoxyglucose positron-emission tomography/CT (18F-FDG-PET/CT). Among the 393 specimens, 132 (33.6%) and 266 (67.7%) were positive for PD-L1 and PD-L2 expression, respectively. Multivariate analysis showed that the absence of surrounding ground glass opacity and the presence of air bronchogram were significantly associated with PD-L2 expression; however, there was no significant association between PD-L2 expression and the consolidation/tumor ratio. In 222 18F-FDG-PET/CT, the maximum standardized uptake value was significantly higher in patients with PD-L2-positive compared to those with PD-L2-negative tumors. PD-L2-positive lung adenocarcinomas are less radiologically malignant and invasive than their PD-L1-positive counterparts.

Air bronchogram: A potential indicator of epidermal growth factor receptor mutation in pulmonary subsolid nodules

ObjectivesEvaluation of pulmonary subsolid nodule is a longstanding clinical problem. We aimed to validate the computed tomography (CT) features correlating with pathological invasiveness and to explore any imaging findings associated with epidermal growth factor receptor (EGFR) mutation in lung adenocarcinoma. MethodsA total of 204 patients with pathologically proven stage IA adenocarcinoma who had preoperative CT and data on EGFR status were enrolled in this retrospective study. Quantitative CT features including tumor size and solid volume proportion (SVP) were measured on multiplanar reconstructed images. Pathological analysis was stratified into adenocarcinoma in situ and minimally invasive adenocarcinoma (AIS/MIA), and invasive adenocarcinomas (IAs). ResultsThere were 93 AIS/MIA and 111 IAs. EGFR mutation was detected in 109 (53.4%) cases. In radiopathological analysis, IAs were significantly in larger tumor size (15.8mm vs. 10.9mm), higher SVP (18.3% vs. 1.1%) and more likely to present air bronchogram, vascular invasion, lobulated/irregular shape, non-smooth margin and pleural tag than AIS/MIA. The multivariate logistic regression indicated that tumor size (OR=1.337) and SVP (OR=1.198) were significant differentiating factors of IAs from AIS/MIA. In radiogenomic analysis, EGFR status differed in tumor size, air bronchogram and margin. The multivariate logistic regression disclosed that the presence of an air bronchogram (OR=3.451) was significantly associated with EGFR mutation after adjustment for age, gender and smoking status. ConclusionsIn subsolid nodules, tumor size and SVP were significant predictors of pathological invasiveness. In addition, the presence of air bronchogram was suggestive of activated EGFR mutation.

Predictors of pathological non-invasive lung cancer with pure-solid appearance on computed tomography to identify possible candidates for sublobar resection.

This study aimed to establish favorable predictors for patients with clinical stage IA radiological pure-solid lung cancer to identify possible candidates for sublobar resection. We examined 275 patients with surgically resected clinical stage IA radiological pure-solid lung cancer. Pathological grade PL0, Ly0, V0, or N0 disease was defined as non-invasive pure-solid lung cancer (NIPS). Nodal involvement was observed in 63 (23%) patients with clinical stage IA pure-solid lung cancer, while NIPS was identified in 77 (28%). Multivariate analysis revealed that air bronchogram (p=0.0328), clinical T1a (p=0.0041), and SUVmax (p=0.0002) were significant clinical predictors of NIPS. When these clinical predictors were combined and the relevant patients' disease was classified as favorable, the frequency of nodal involvement was only 4%. Furthermore, the 3-year overall survival (OS) of the patients with "favorable" clinical stage IA pure-solid lung cancer was 100% despite their operative modes. In contrast, the 3-year OS even for patients with clinical stage IA disease, if they had neither of these clinical predictors, was 74.1%. Tumor size, the presence of air bronchogram, and the SUVmax level were significant favorable predictors of pathological non-invasive status, and patients with these clinical predictors could be candidates for sublobar resection for clinical stage IA pure-solid lung cancers.

Morphological factors differentiating between early lung adenocarcinomas appearing as pure ground-glass nodules measuring ≤10mm on thin-section computed tomography.

BackgroundWe aimed to compare the morphological features of pure ground-glass nodules (GGNs; diameter, ≤10 mm) on thin-section computed tomography (TSCT) with their histopathological results in order to identify TSCT features differentiating between atypical adenomatous hyperplasia (AAH), adenocarcinoma in situ (AIS) and minimally invasive adenocarcinoma (MIA).MethodsBetween January and December 2013, 205 pure GGNs with a diameter ≤10 mm on TSCT were pathologically confirmed as AAH (40), AIS (95) or MIA (70) lesions. The patients’ age and sex were recorded. The morphological features were evaluated, and maximum diameter and mean CT value were measured for each nodule. F test, Pearson χ2 test, Fisher exact test and multinomial logistic regression analysis were used to identify factors differentiating between AAH, AIS and MIA. Receiver operating characteristic (ROC) curve analysis was performed for maximum diameter and mean CT value.ResultsF test, Pearson χ2 test and Fisher exact test revealed that maximum diameter (P <0.00001), mean CT value (P =0.005), type of interface (P =0.005) and presence of air bronchograms (P =0.02, n =44) significantly differed among the AAH, AIS and MIA groups. Multinomial logistic regression analysis showed that maximum diameter ≥6.5 mm, a well-defined and coarse interface indicated AIS or MIA rather than AAH; air bronchograms differentiated MIA from AAH; but these parameters did not differentiate between AIS and MIA. A mean CT value less than −520 HU indicated AAH or AIS rather than MIA, but did not differentiate between AAH and AIS.ConclusionsIn the case of pure GGNs measuring ≤10 mm, a maximum diameter ≥6.5 mm, a well-defined and coarse interface indicate AIS or MIA rather than AAH; an air bronchogram can differentiate MIA from AAH. A mean CT value less than −520 HU indicates AAH or AIS rather than MIA.

The presence of air bronchogram is a novel predictor of negative nodal involvement in radiologically pure-solid lung cancer

Phase III trials regarding the feasibility of segmentectomy for lung cancer ≤ 2 cm in size are now underway in Japan and the USA. However, despite their small size, lung cancers that show a pure-solid appearance on thin-section computed tomography (CT) are considered to be invasive with a high frequency of nodal involvement. Between 2008 and 2011, 556 clinical Stage IA lung cancer patients underwent pulmonary resection. For all patients, the findings obtained by preoperative thin-section CT were reviewed and the maximum standardized uptake value (SUVmax) on positron emission tomography was recorded. Several clinicopathological features were investigated to identify predictors of nodal metastasis using multivariate analyses. One hundred and eighty-four clinical Stage IA lung cancer patients showed a pure-solid appearance on thin-section CT. Among them, air bronchogram was found radiologically in 58 (32%) patients. Nodal involvement was observed in 10 (17%) patients with air bronchogram, compared with 43 (34%) without air bronchogram, in clinical Stage IA pure-solid lung cancer. A multivariate analysis revealed that air bronchogram, clinical T1a and SUVmax were significant predictors of postoperative nodal involvement (P < 0.01, <0.01, and 0.03, respectively). Furthermore, nodal metastasis was never seen in patients with clinical T1a pure-solid lung cancers who had both air bronchogram and low SUVmax. The presence of air bronchogram was a novel predictor of negative nodal involvement in clinical Stage IA pure-solid lung cancer. Segmentectomy with thorough lymph node dissection is a feasible option for these patients despite a pure-solid appearance.