Treatment Of Pulmonary Nodules Research Articles

Network pharmacology and molecular docking analysis on the mechanism of Wensan tincture in the treatment of pulmonary nodules: A review.

Network pharmacology and molecular docking methods were applied to elucidate the molecular mechanism of action of Wensan tincture (WST) in the treatment of pulmonary nodules. The Traditional Chinese Medicine Systems Pharmacology and the Traditional Chinese Medicine and Chemical Composition database were used to screen the active ingredients. Potential targets of WST were retrieved using Traditional Chinese Medicine Systems Pharmacology, SwissADME, and SwissTargetPrediction, while pulmonary nodule-associated targets were obtained from GeneCards and Online Mendelian Inheritance in Man databases. An active ingredient-target network was constructed using Cytoscape 3.9.1, and Gene Ontology and Kyoto Encyclopedia of Genes and Genomes enrichment analyses were conducted via the Database for Annotation, Visualization, and Integrated Discovery platform to identify core targets and signaling pathways. Molecular docking studies were performed using AutoDockTools. The results revealed 62 active ingredients and 344 corresponding targets within the tincture, alongside 1005 targets associated with pulmonary nodules. Gene Ontology and Kyoto Encyclopedia of Genes and Genomes enrichment analyses indicated that the potential therapeutic targets of WST include signal transducer and activator of transcription 3, mitogen-activated protein kinase-3, mitogen-activated protein kinase-1, Jun proto-oncogene, tumor protein 53, phosphoinositide-3-kinase regulatory subunit 1, heat shock protein 90 alpha family class A member 1, and AKT serine/threonine kinase 1. The primary pathways were the cancer pathway, mitogen-activated protein kinase signaling, advanced glycation end-products and their receptor signaling, epidermal growth factor receptor signaling, hypoxia-inducible factor-1 signaling, and the programmed cell death-ligand 1/programmed cell death protein 1 checkpoint pathways. Molecular docking demonstrated that quercetin exhibited the strongest binding affinity with mitogen-activated protein kinase-3, with a binding energy of -9.1 kcal/mol. Notably, key components of WST, such as quercetin, demonstrate considerable potential as drug candidates for the treatment of pulmonary nodules.

Chinese expert consensus on diagnosis and treatment of pulmonary nodules(2024)

Lung cancer is the leading cause of the incidence and mortality of malignant tumors in China. The 5-year survival rate released for China in 2018 was 19.7%. The 5-year survival rate for stage Ⅰ patients is 77%-92%. Early diagnosis and treatment of lung cancer are key to improving the 5-year overall survival rate and prognosis of lung cancer patients. Therefore, experts from the Academic Group of Lung Cancer in Chinese Thoracic Society and Chinese Alliance Against Lung Cancer Expert Group formulated the Chinese Expert Consensus on the Diagnosis and Treatment of Lung Nodules in 2015 to standardize the diagnosis and treatment of lung nodules. In 2018, this consensus was updated to formulate the Chinese Expert Consensus on Diagnosis and Treatment of Lung Nodules (2018 edition), and widely applied in multiple branch centers of Chinese Alliance Against Lung Cancer, proposing the Intelligent Treatment of Million Early Lung Cancer Project. Based on applied experience of the expert consensus in recent years, with reference to the latest evidence has been updated, Chinese Expert Consensus on Diagnosis and Treatment of Lung Nodules (2024 edition) was formulated. The updated content of this consensus mainly includes the following aspects: (1) Define the screening age of high-risk lung cancer populations in China based on the national conditions; (2) Propose definition of "difficult-to-determine pulmonary nodules" to avoid delaying the diagnosis and treatment; (3) Evaluate pulmonary nodules assisted by artificial intelligence (AI) imaging-assisted diagnostic system and propose human-machine MDT to avoid the limitations of AI; (4) Evaluate pulmonary nodules by routine and individualized evaluations for different populations, and make recommendations based on evidence-based management guidelines for different types and sizes of pulmonary nodules. In the updated consensus, 18 consensus points were recommended as a reference for clinical management of pulmonary nodules to improve the 5-year overall survival rate and the prognosis of lung cancer in China.

Shared decision-making in the management of pulmonary nodules: a systematic review of quantitative and qualitative studies

ObjectiveThe objective of this systematic review was to explore the evidence regarding shared decision-making (SDM) in the management of pulmonary nodules.DesignSystematic review of quantitative and qualitative studies.Data sourceStudies published in...

Experts consensus on transbronchial diagnosis, localization and treatment of peripheral pulmonary nodules guided by the augmented reality optical lung navigation

Lung cancer is the second most common malignancy with the highest mortality rate worldwide. In recent years, the rapid development of various bronchoscopic navigation techniques has provided conditions for the minimally invasive diagnosis and treatment of peripheral pulmonary nodules through the airway.Augmented reality optical lung navigation is a new technology that combined virtual bronchoscopy navigation (VBN) with augmented reality (AR) and optical navigation technology, which could assist bronchoscopist and has been widely applied in clinics. The clinical evidence certified that the navigation, has the advantages of safety and efficacy in guiding transbronchial diagnosis, localization, and treatment of pulmonary nodules. In order to standardize the clinical operation of augmented reality optical lung navigation technology and guide its application in clinical practice, Interventional Group, Society of Respiratory Diseases, Chinese Medical Association/Interventional Pulmonology Group of the Zhejiang Medical Association organized multidisciplinary experts to take the lead in formulating the Consensus of experts on transbronchial diagnosis, localization and treatment of peripheral pulmonary nodules guided by the augmented reality optical lung navigation after multiple rounds of discussion, and provided recommendation opinions and clinical guidance for the indications and contraindications, equipment and devices, perioperative treatment, operating process and complication management of peripheral pulmonary nodules applicable to augmented reality optical lung diagnosis navigation technology.

Chinese expert consensus on cone-beam CT-guided diagnosis, localization and treatment for pulmonary nodules.

Cone-beam computed tomography (CBCT) system can provide real-time 3D images and fluoroscopy images of the region of interest during the operation. Some systems can even offer augmented fluoroscopy and puncture guidance. The use of CBCT for interventional pulmonary procedures has grown significantly in recent years, and numerous clinical studies have confirmed the technology's efficacy and safety in the diagnosis, localization, and treatment of pulmonary nodules. In order to optimize and standardize the technical specifications of CBCT and guide its application in clinical practice, the consensus statement has been organized and written in a collaborative effort by the Professional Committee on Interventional Pulmonology of China Association for Promotion of Health Science and Technology.

Analysis on the Rule of Medication in the Treatment of Pulmonary Nodules by Professor Ma Zhanping

Analysis on the Rule of Medication in the Treatment of Pulmonary Nodules by Professor Ma Zhanping

A 3D Digital Model for the Diagnosis and Treatment of Pulmonary Nodules

The three-dimensional (3D) reconstruction of pulmonary nodules using medical images has introduced new technical approaches for diagnosing and treating pulmonary nodules, and these approaches are progressively being acknowledged and adopted by physicians and patients. Nonetheless, constructing a relatively universal 3D digital model of pulmonary nodules for diagnosis and treatment is challenging due to device differences, shooting times, and nodule types. The objective of this study is to propose a new 3D digital model of pulmonary nodules that serves as a bridge between physicians and patients and is also a cutting-edge tool for pre-diagnosis and prognostic evaluation. Many AI-driven pulmonary nodule detection and recognition methods employ deep learning techniques to capture the radiological features of pulmonary nodules, and these methods can achieve a good area under-the-curve (AUC) performance. However, false positives and false negatives remain a challenge for radiologists and clinicians. The interpretation and expression of features from the perspective of pulmonary nodule classification and examination are still unsatisfactory. In this study, a method of continuous 3D reconstruction of the whole lung in horizontal and coronal positions is proposed by combining existing medical image processing technologies. Compared with other applicable methods, this method allows users to rapidly locate pulmonary nodules and identify their fundamental properties while also observing pulmonary nodules from multiple perspectives, thereby providing a more effective clinical tool for diagnosing and treating pulmonary nodules.

Efficacy and Safety of Chinese Medicine in the Treatment of Patients with Pulmonary Nodules-A Multicenter Open Label Randomized Controlled Study: A Study Protocol for a Randomized Controlled Trial

As the popularity of early screening of tumors, more and more people have detected pulmonary nodules, of which about 3.48% was lung cancer. However, false positive rates accounted for 1.4-23.3% according to trials reported. Therefore, pulmonary nodules may be over treated. In the clinical practice, we found that traditional Chinese medicine treatment makes some patients’ lung nodules shrink or even disappear but this effect needs to be approved. Therefore, we design this global network randomized controlled study (RCT) study to explore the efficacy and safety of traditional Chinese medicine in the treatment of pulmonary nodules. This study is a multicenter, open, prospective, randomized, controlled study. In this study, participants will be randomly assigned to traditional Chinese medicine or routine treatment observation group. About 166 patients with pulmonary nodules will be registered within 12 months and followed up for at least 2 years. The important feature of this clinical trial is to provide services to patients with pulmonary nodules worldwide by combining online and offline diagnosis and treatment, excluding interference factors such as region, climate, environment, eating habits etc. At the same time, it also will save costs and improves patient compliance. This trial design will also conduct subgroup analysis on the population of traditional Chinese medicine in the treatment of pulmonary nodules and establish a mathematical model to analyze the dominant population of traditional Chinese medicine in pulmonary nodules and the predictive factors of curative effect.

Lung Nodule Marking With ICG Dye–Soaked Coil Facilitates Localization and Delayed Surgical Resection

BackgroundWhereas diagnosis and treatment of pulmonary nodules may be combined during a surgical resection, this approach may lead to excision of benign lesions and excessive healthy lung tissue if the lesion is difficult to localize. Bronchoscopy-guided marking of pulmonary nodules before surgery may facilitate this process, but it is limited by current technologies and often challenging as dye marking may dissipate if surgery is performed days later. We present a novel method to address this problem that allows surgery multiple days after lesion marking with accurate localization. MethodsFour patients with newly identified lung nodules underwent robot-assisted navigation bronchoscopy with lesion marking with a fiducial coil saturated for 10 minutes with indocyanine green (ICG) dye and subsequent thoracic surgery. ResultsThe novel approach to soaking the fiducial in ICG allowed the lesions to be seen multiple days (0-9 days) later at the time of da Vinci robotic surgery with the Firefly fluorescence imaging system. No evidence of dye dispersion was visualized, and all surgeries were completed without complications. ConclusionsMethods to improve peripheral pulmonary nodule marking to facilitate surgical resection are imperative as more asymptomatic, smaller lesions continue to be identified. In our initial experience, placement of ICG dye–soaked fiducial coils for lung nodule marking multiple days before thoracic surgery appears to be a viable option to facilitate surgical resection.

Pulmonary nodules, is there any pathogenesis evidence?

Theory and treatment of pulmonary nodules is under-investigated in the clinic. Diagnostic and therapeutic norm is waiting for updating. This editorial highlights the pathogenesis and treatment of pulmonary nodes is.

Visualized analysis of knowledge map for traditional Chinese medicine prevention and treatment of pulmonary nodules based on CiteSpace

This study aims to analyze the current status and development trend of the prevention and treatment of pulmonary nodules(PN) with traditional Chinese medicine(TCM) based on knowledge map and to provide both references and suggestions for future research directions. CNKI, Wanfang, VIP, and SinoMed were searched for relevant papers from the inception to December 31, 2021. Eligible articles were included according to the inclusion and exclusion criteria. The line chart was drawn based on the annual publication volume of articles, and the research interests of this field were learned. The knowledge maps of prevention and treatment of PN with TCM were drawn in CiteSpace 5.8.R1, and the authors, institutions, contents, and hotspots were analyzed. A total of 122 articles were included and the line chart demonstrated that the annual publication volume has been rising since 2018. According to the knowledge maps, the most prolific author was ZHANG Xiao-mei and there were four main research teams. Beijing University of Chinese Medicine and its affiliated hospitals were in a leading position in this field. The main research contents were disease, pathogenesis, and treatment, and the hotspots were data mining and TCM syndrome. The research on prevention and treatment of PN with TCM has become an increasing field of interest in recent years. In the future, the cross-regional cooperation and communication between research teams and institutions should be strengthened for more real-world studies and basic studies about the prevention and treatment of PN with TCM, so that the high-level evidence can be obtained and the underlying mechanisms of TCM formulae in the treatment of PN be clarified.

A multidimensional model incorporating radiomics score and liquid biopsy for the prediction of malignant and benign pulmonary nodules.

As the lesions in pulmonary nodules (PNs) are small and the clinical manifestations lack specificity, the etiology of PNs is complex, predisposing them to misdiagnoses missed diagnoses. Thus, the diagnosis and treatment of PNs remains challenging and an important clinical problem. This study prospectively enrolled 156 patients with computed tomography (CT)-diagnosed PNs who underwent circulating genetically abnormal cell (CAC) testing between January 2020 and December 2021. We collected data on clinical features closely related to the nature of PNs, such as age, smoking history, and type of nodule. All internal regions of interest (ROIs) of PNs in this study were segmented. Radiomic feature extraction was performed on the ROIs, and a radiomics model was constructed using least absolute shrinkage and selection operator (LASSO) regression to obtain a radiomics score (Rad-score). A comprehensive model combining clinical features, Rad-score, and liquid biopsy was constructed using logistic regression analysis. The diagnostic performance of the model was evaluated using receiver operating characteristic (ROC) curves. In this study, 5 radiomics features were screened for model construction. The area under the ROC curve (AUC) of the radiomics model was 0.844 [95% confidence interval (CI): 0.766-0.915] in the training set. The Rad-score, clinical features, and CAC were further combined to construct a multidimensional analysis model. The AUC of the synthesized model was 0.943 (95% CI: 0.881-0.978) in the training set. A multidimensional model is an effective tool for the noninvasive diagnosis of malignant PNs. The validation and combination of multiple diagnostic methods is a productive avenue of research trend for the identification of malignant PNs.

3D localization based on anatomical LANDmarks in the treatment of pulmonary nodules.

BackgroundVarious methods exist for locating lung nodules, each with its own advantages and disadvantages. Aiming to find a more accurate, safe, effective, economical and practical method for locating lung nodules, this study evaluated the safety and feasibility of a precise three-dimensional (3D) method for positioning small pulmonary nodules based on anatomical landmarks.MethodsFrom June 2019 to December 2021, 120 patients with 131 pulmonary nodules who underwent video-assisted thoracoscopic surgery at the University of Hong Kong-Shenzhen Hospital were included in the study. Surgical data such as the positioning time, accuracy rate, pathological result, localization-related complication rate and length of postoperative hospital stay were retrospectively reviewed and analyzed. During surgery, pulmonary nodules were accurately located by the 3D positioning method based on anatomical landmarks and then removed to determine the pathology.ResultsA total of 120 patients, including 35 males and 85 females, were included, and the median age was 53 years [interquartile range (IQR), 41–63 years]. No mortality or major morbidity occurred within 30 days. The median localization time was 11 minutes (IQR, 8–14 minutes). The accuracy of localization was 98.5%. The median diameter of the pulmonary nodules was 8 mm (IQR, 7–13 mm), and the median distance from the visceral pleura was 6 mm (IQR, 2–10 mm). No location-related complications occurred. The median length of postoperative hospital stay was 5 days (IQR, 3–7 days).ConclusionsThe proposed positioning method is accurate, safe and feasible for selected patients with pulmonary nodules. Compared with other preoperative and intraoperative positioning methods, it can significantly reduce localization-related complications.

Relationship between EGFR, ALK Gene Mutation and Imaging and Pathological Features in Invasive Lung Adenocarcinoma

背景与目的当前针对肺腺癌表皮生长因子受体(epidermal growth factor receptor, EGFR)与间变性淋巴瘤激酶(anaplastic lymphoma kinase, ALK)基因突变位点的靶向治疗研究进展十分迅速，为晚期肺腺癌患者的治疗带来新的希望，然而目前EGFR、ALK基因突变在腺癌患者中所具有的特异性影像学与病理学特征仍存在较多争议，本研究进一步探索浸润性肺腺癌EGFR、ALK基因突变与影像学、病理学特征的相关性。方法纳入2018年1月-2019年12月在我们中心接受手术的525例肺腺癌患者。根据术后基因检测的结果将患者分为EGFR基因、ALK基因突变组与野生组，并将EGFR基因突变组分层为外显子19、外显子21突变亚型，将突变组与野生组的病理学特征如组织学亚型、淋巴结转移、脏层胸膜侵犯(visceral pleural invision, VPI)等，影像学特征如肿瘤最大直径、实性成分占比(consolidation tumor ratio, CTR)、分叶征、毛刺征、胸膜牵拉征、空气支气管征、空泡征等进行单因素分析及多因素逻辑回归分析，探讨基因突变组是否具有特异性表现。结果EGFR基因突变组常见于女性(OR=2.041, P=0.001)，存在更多胸膜牵拉征征象(OR=1.506, P=0.042)，病理学上与淋巴结转移及VPI相关性较小(P > 0.05)。其中外显子21突变型腺癌多见于年龄相对较大者(OR=1.022, P=0.036)及女性(OR=2.010, P=0.007)，常伴有较大肿瘤直径(OR=1.360, P=0.039)及胸膜牵拉征(OR=1.754, P=0.029)。外显子19突变型腺癌常见于女性(OR=2.230, P=0.009)、肿瘤实性成分比例较高(OR=1.589, P=0.047)、存在更多分叶征(OR=2.762, P=0.026)。ALK基因突变易发生于有吸烟史(OR=2.950, P=0.045)及较年轻患者(OR=1.070, P=0.002)，病理学上存在更多微乳头型成分(OR=4.184, P=0.019)及VPI(OR=2.986, P=0.034)。结论EGFR、ALK基因突变型腺癌具有特异的影像学及临床病理学特征，且EGFR外显子19或21突变具有不同的影像学特征，对制定肺结节临床处理策略具有重要意义。

Advances of Electromagnetic Navigation Bronchoscopy for Peripheral Pulmonary Lesions

随着计算机断层扫描的筛查应用普及，越来越多的外周肺部病变被发现，外周肺病变的诊断和治疗是目前临床较为棘手的问题之一。电磁导航支气管镜以电磁定位技术为基础，经支气管到达外周肺部病变进行活检或治疗，为肺部可疑病灶提供了新的微创诊治方法。本文将综述电磁导航支气管镜在外周肺病变诊治中的临床应用现状及进展。

Value of the Hybrid Operating Theater for an Integrated Approach to Diagnosis and Treatment of Pulmonary Nodules in 2019.

Value of the Hybrid Operating Theater for an Integrated Approach to Diagnosis and Treatment of Pulmonary Nodules in 2019.

Treatment of pulmonary nodule: from VATS to RATS.

The incidental detection of solitary pulmonary nodule (SPN) is currently increasing due to the widespread use of computed tomography (CT) during the follow up in oncological patients or in screening trials. A quick and definitive histological diagnosis of these nodes is mandatory as, in case of primitive lung cancer, an early detection could improve both surgical results and prognosis. The minimally invasive pulmonary resection (MIPR) is the gold standard procedure for diagnosis and treatment of small lung nodules, but it can be difficult to localize deep nonpalpable nodes that lie in the lung parenchyma. Hence, throughout the years several techniques have been developed to better localize deep or sub solid nodes. We describe our experience with radio-guided technique. Patients with SPN smaller than 10 mm and/or with a distance from the visceral pleura equal or larger than 10 mm underwent MIPR after CT injection of a solution containing 0.2 mL 99Tc-labelled human serum albumin microspheres and 0.1 mL of non-ionic contrast. During surgical procedures, a collimated probe, connected to a gamma-ray detector, was used to scan the lung and detect the target area. The area of major radioactivity was then resected. Between 2010 and 2015, 175 patients (M/F: 97/78) underwent minimally invasive resection (thoracoscopic or robotic) with radio-guided technique. The mean node diameter was 13 mm (range, 5-20 mm), and the mean distance from the visceral pleura was 15 mm (range, 6-39 mm). No significant CT-guided-injection-related complications occurred, except for 13 patients (7.4%) who developed a pneumothorax (PNX) not requiring chest tube insertion. This technique guaranteed a successfully intra-operative node localization in 100% of cases. The mean duration of the surgical procedure was 44 min (range, 25-130 min). The mean length of pleural drainage and mean hospital stay was 2.6 days (range, 1-5 days) and 3.9 days (range, 1-7 days) respectively. No mortality or perioperative complications occurred. Pathology reports showed 105 metastases, 55 primitive lung cancers and 15 benign lesions. In case of suspicion of primitive lung tumour an intraoperative frozen exam was conducted, and all patients underwent lobectomy or segmentectomy with lymphadenectomy [41 patients with thoracotomy, 11 with robotic surgery and 3 with video-assisted thoracoscopic surgery (VATS)]. Our experience confirms that radio-guided thoracoscopic surgery (RGTS) is a feasible and safe procedure, thanks to its high success rate the radio-guided technique is helpful to overcome the lack of tactile feedback during MIPR [VATS and robotic-assisted thoracoscopic surgery (RATS)] and to limit conversion to open surgery.

P1.03-057 Assessment of Lung Cancer Risk- Regional Respiratory Disease Screening Report in Jilin, China

Both morbidity and mortality of lung cancer ranks first in China. According to the “2012 cancer registration report of China“, Northeast China is a high prevalence area of lung cancer, so early diagnosis of lung cancer is particularly important. Based on this, we made the regional survey in Changchun city. (1) To investigate the incidence of pulmonary nodules and lung cancer in Changchun city. (2)To provide the foundation of large data study on early screening of lung cancer and disease control. Carry out the investigation of the people over 50 years of age in 10 communities in Changchun of Jilin Province (A total of 1461 people), including questionnaire, pulmonary function tests and low-dose spiral CT examination. The disease assessment and patient management are based on “Diagnosis and treatment of pulmonary nodules in Chinese expert consensus.” The percentage of lung disease in the investigated population was 25.67%, and the constitution of the lung disease included: 30.67% of the lung nodules, 37.07% of chronic obstructive pulmonary disease, 18.67% of inflammation, 5.6% of the lung, 2.13% of pulmonary interstitial fibrosis, 2.13% of pleural effusion and 3.73% of other lung diseases. The number of pulmonary nodules was 115, accounting for 7.87% of the total number of screening, 89 cases of solitary nodules, 26 cases of multiple nodules. A total of 4 patients with lung cancer were confirmed by pathology, including 2 cases of adenocarcinoma, 1 case of squamous cell carcinoma and 1 case of mucinous carcinoma of the lung. All of the cancer cases were solitary nodules, and accounted for 3.48% of the total samples. Among them, 3 patients are male with a history of smoking, and 1 is female without any history of smoking. According to the nodule size, the diameters of nodule in 3 cases are greater than 8mm and 1 case is less than 4mm. According to the quality of nodules, 3 cases are solid and mixed nodules, and 1 case is ground-glass opacity. (1) Smoking is a risk factor for lung cancer. (2) Solid and mixed character nodules in pulmonary nodules and larger diameter nodules are more likely to develop into cancer, so they should be strengthened management. (3) Low-dose spiral CT is helpful for early diagnosis of lung cancer.