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Sample records for small lung nodules

  1. The probability of malignancy in small pulmonary nodules coexisting with potentially operable lung cancer detected by CT

    International Nuclear Information System (INIS)

    Yuan, Yue; Matsumoto, Tsuneo; Hiyama, Atsuto; Miura, Goji; Tanaka, Nobuyuki; Emoto, Takuya; Kawamura, Takeo; Matsunaga, Naofumi

    2003-01-01

    The aim of this study was to assess the probability of malignancy in one or two small nodules 1 cm or less coexisting with potentially operable lung cancer (coexisting small nodules). The preoperative helical CT scans of 223 patients with lung cancer were retrospectively reviewed. The probability of malignancy of coexisting small nodules was evaluated based on nodule size, location, and clinical stage of the primary lung cancers. Seventy-one coexisting small nodules were found on conventional CT in 58 (26%) of 223 patients, and 14 (6%) patients had malignant nodules. Eighteen (25%) of such nodules were malignant. The probability of malignancy was not significantly different between two groups of nodules larger and smaller than 0.5 cm (p=0.1). The probability of malignancy of such nodules within primary tumor lobe was significantly higher than that in the other lobes (p<0.01). Metastatic nodules were significantly fewer in clinical stage-IA patients than in the patients with the other stage (p<0.01); however, four (57%) of seven synchronous lung cancers were located in the non-primary tumor lobes in the clinical stage-I patients. Malignant coexisting small nodules are not infrequent, and such nodules in the non-primary tumor lobes should be carefully diagnosed. (orig.)

  2. Importance of scatter compensation algorithm in heterogeneous tissue for the radiation dose calculation of small lung nodules. A clinical study

    International Nuclear Information System (INIS)

    Baba, Yuji; Murakami, Ryuji; Mizukami, Naohisa; Morishita, Shoji; Yamashita, Yasuyuki; Araki, Fujio; Moribe, Nobuyuki; Hirata, Yukinori

    2004-01-01

    The purpose of this study was to compare radiation doses of small lung nodules calculated with beam scattering compensation and those without compensation in heterogeneous tissues. Computed tomography (CT) data of 34 small (1-2 cm: 12 nodules, 2-3 cm 11 nodules, 3-4 cm 11 nodules) lung nodules were used in the radiation dose measurements. Radiation planning for lung nodule was performed with a commercially available unit using two different radiation dose calculation methods: the superposition method (with scatter compensation in heterogeneous tissues), and the Clarkson method (without scatter compensation in heterogeneous tissues). The energy of the linac photon used in this study was 10 MV and 4 MV. Monitor unit (MU) to deliver 10 Gy at the center of the radiation field (center of the nodule) calculated with the two methods were compared. In 1-2 cm nodules, MU calculated by Clarkson method (MUc) was 90.0±1.1% (4 MV photon) and 80.5±2.7% (10 MV photon) compared to MU calculated by superposion method (MUs), in 2-3 cm nodules, MUc was 92.9±1.1% (4 MV photon) and 86.6±2.8% (10 MV photon) compared to MUs, and in 3-4 cm nodules, MUc was 90.5±2.0% (4 MV photon) and 90.1±1.7% (10 MV photon) compared to MUs. In 1-2 cm nodules, MU calculated without lung compensation (MUn) was 120.6±8.3% (4 MV photon) and 95.1±4.1% (10 MV photon) compared to MU calculated by superposion method (MUs), in 2-3 cm nodules, MUc was 120.3±11.5% (4 MV photon) and 100.5±4.6% (10 MV photon) compared to MUs, and in 3-4 cm nodules, MUc was 105.3±9.0% (4 MV photon) and 103.4±4.9% (10 MV photon) compared to MUs. The MU calculated without lung compensation was not significantly different from the MU calculated by superposition method in 2-3 cm nodules. We found that the conventional dose calculation algorithm without scatter compensation in heterogeneous tissues substantially overestimated the radiation dose of small nodules in the lung field. In the calculation of dose distribution of small

  3. Can Lung Nodules Be Cancerous?

    Science.gov (United States)

    ... lung nodules be cancerous? Answers from Eric J. Olson, M.D. Yes, lung nodules can be cancerous, ... to determine if it's cancerous. With Eric J. Olson, M.D. AskMayoExpert. Pulmonary nodules. Rochester, Minn.: Mayo ...

  4. Role of high-resolution CT in the diagnosis of small pulmonary nodules coexisting with potentially operable lung cancer

    International Nuclear Information System (INIS)

    Yuan, Yue; Matsumoto, Tsuneo; Hiyama, Atsuto; Miura, Goji; Tanaka, Nobuyuki; Matsunaga, Naofumi

    2002-01-01

    The purpose of this study was to evaluate whether high-resolution CT (HRCT) could facilitate the preoperative diagnosis of one or two small nodules of 1 cm or less coexisting with a lung cancer, i.e., coexisting small nodule. This study included 27 coexisting small nodules in 24 potentially operable lung cancer patients. An observer study was performed by five radiologists. The observer performances in differentiating malignant from benign coexisting small nodules were evaluated on conventional CT and HRCT using receiver operating characteristic (ROC) analysis. The area under the ROC curve of five observers was 0.731 on HRCT and 0.578 on conventional CT in the differential diagnosis of coexisting small nodules. A significant diagnostic improvement was found on HRCT (p=0.031). This was especially evident for nodules of ground-glass attenuation (p=0.005). HRCT plays an important role in determining the treatment of potentially operable lung cancer patients with coexisting small nodules. (author)

  5. An Innocent Appearing Subcutaneous Nodule Diagnoses a Small Cell Lung Cancer in a Never-Smoker Female

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    Nupur Sinha

    2014-01-01

    Full Text Available Lung cancer among never-smokers is recognized as the 7th most common cause of cancer death globally. Adenocarcinoma is the most commonly reported histology. Small cell lung cancer (SCLC has the strongest association with smoking and is rarely reported in never-smokers. Although lung cancer in never-smokers is more common in women, the overall incidence of SCLC in female never-smokers still remains low. Soft tissue metastases from any cancer are rare with an overall prevalence of 1.8%. Soft tissue metastases from lung primary are uncommon, mostly from adenocarcinoma, and portend a poor prognosis. Cutaneous metastases from SCLC are exceptionally rare with reported incidence of 0.3% to 0.8%. We believe ours is the first reported case of SCLC presenting as subcutaneous nodule, in a never-smoker, otherwise asymptomatic female. The diagnosis of SCLC was made incidentally by the excisional biopsy of the subcutaneous nodule. Subsequent CT chest and PET scan revealed a hypermetabolic right lower lobe spiculated lung mass with adrenal and liver involvement. Platinum and etoposide chemotherapy with prophylactic cranial irradiation was initiated for advanced SCLC, and she required further irinotecan and taxol for subsequent pancreatic and adrenal metastases. With continued deterioration, she died approximately 36 months from diagnosis, while under hospice care.

  6. Detection of small pulmonary nodules in high-field MR at 3 T: evaluation of different pulse sequences using porcine lung explants

    International Nuclear Information System (INIS)

    Regier, M.; Kaul, M.G.; Ittrich, H.; Bansmann, P.M.; Kemper, J.; Nolte-Ernsting, C.; Adam, G.; Kandel, S.; Hoffmann, B.; Heller, M.; Biederer, J.

    2007-01-01

    To evaluate two MR imaging sequences for the detection of artificial pulmonary nodules inside porcine lung explants. 67 agarose nodules ranging 3-20 mm were injected into ten porcine lungs within a dedicated chest phantom. The signal on T1-weighted images and radiopacity were adjusted by adding 0.125 mmol/l Gd-DTPA and 1.5 g/l of iodine. A T1-weighted three-dimensional gradient-echo (T1-3D-GRE; TR/TE:3.3/1.1 ms, slice:8 mm, flip-angle:10 ) and a T2-weighted half-Fourier fast-spin echo sequence (T2-HF-FSE; TR/TE:2000/66 ms, slice:7 mm, flip-angle:90 ) were applied in axial orientation using a 3-T system (Intera, Philips Medical Systems, Best, The Netherlands), followed by CT (16 x 0.5 mm) as reference. Nodule sizes and locations were assessed by three blinded observers. In nodules of >10 mm, sensitivity was 100% using 3D-GRE-MRI and 94% using the HF-FSE sequence. For nodules 6-10 mm, the sensitivity of MRI was lower than with CT (3D-GRE:92%; T2-HF-FSE:83%). In lesions smaller than 5 mm, the sensitivity declined to 80% (3D-GRE) and 53% (HF-FSE). Small lesion diameters were overestimated with both sequences, particularly with HF-FSE. This study confirms the feasibility of 3 T-MRI for lung nodule detection. In lesions greater than 5 mm, the sensitivity of the 3D-GRE sequence approximated CT (>90%), while sensitivity and PPV with the HF-FSE sequence were slightly inferior. (orig.)

  7. Thoracoscopic anatomical lung segmentectomy using 3D computed tomography simulation without tumour markings for non-palpable and non-visualized small lung nodules.

    Science.gov (United States)

    Kato, Hirohisa; Oizumi, Hiroyuki; Suzuki, Jun; Hamada, Akira; Watarai, Hikaru; Sadahiro, Mitsuaki

    2017-09-01

    Although wedge resection can be curative for small lung tumours, tumour marking is sometimes required for resection of non-palpable or visually undetectable lung nodules as a method for identification of tumours. Tumour marking sometimes fails and occasionally causes serious complications. We have performed many thoracoscopic segmentectomies using 3D computed tomography simulation for undetectable small lung tumours without any tumour markings. The aim of this study was to investigate whether thoracoscopic segmentectomy planned with 3D computed tomography simulation could precisely remove non-palpable and visually undetectable tumours. Between January 2012 and March 2016, 58 patients underwent thoracoscopic segmentectomy using 3D computed tomography simulation for non-palpable, visually undetectable tumours. Surgical outcomes were evaluated. A total of 35, 14 and 9 patients underwent segmentectomy, subsegmentectomy and segmentectomy combined with adjacent subsegmentectomy, respectively. All tumours were correctly resected without tumour marking. The median tumour size and distance from the visceral pleura was 14 ± 5.2 mm (range 5-27 mm) and 11.6 mm (range 1-38.8 mm), respectively. Median values related to the procedures were operative time, 176 min (range 83-370 min); blood loss, 43 ml (range 0-419 ml); duration of chest tube placement, 1 day (range 1-8 days); and postoperative hospital stay, 5 days (range 3-12 days). Two cases were converted to open thoracotomy due to bleeding. Three cases required pleurodesis for pleural fistula. No recurrences occurred during the mean follow-up period of 44.4 months (range 5-53 months). Thoracoscopic segmentectomy using 3D computed tomography simulation was feasible and could be performed to resect undetectable tumours with no tumour markings. © The Author 2017. Published by Oxford University Press on behalf of the European Association for Cardio-Thoracic Surgery. All rights reserved.

  8. Lung Nodule Detection via Deep Reinforcement Learning

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    Issa Ali

    2018-04-01

    Full Text Available Lung cancer is the most common cause of cancer-related death globally. As a preventive measure, the United States Preventive Services Task Force (USPSTF recommends annual screening of high risk individuals with low-dose computed tomography (CT. The resulting volume of CT scans from millions of people will pose a significant challenge for radiologists to interpret. To fill this gap, computer-aided detection (CAD algorithms may prove to be the most promising solution. A crucial first step in the analysis of lung cancer screening results using CAD is the detection of pulmonary nodules, which may represent early-stage lung cancer. The objective of this work is to develop and validate a reinforcement learning model based on deep artificial neural networks for early detection of lung nodules in thoracic CT images. Inspired by the AlphaGo system, our deep learning algorithm takes a raw CT image as input and views it as a collection of states, and output a classification of whether a nodule is present or not. The dataset used to train our model is the LIDC/IDRI database hosted by the lung nodule analysis (LUNA challenge. In total, there are 888 CT scans with annotations based on agreement from at least three out of four radiologists. As a result, there are 590 individuals having one or more nodules, and 298 having none. Our training results yielded an overall accuracy of 99.1% [sensitivity 99.2%, specificity 99.1%, positive predictive value (PPV 99.1%, negative predictive value (NPV 99.2%]. In our test, the results yielded an overall accuracy of 64.4% (sensitivity 58.9%, specificity 55.3%, PPV 54.2%, and NPV 60.0%. These early results show promise in solving the major issue of false positives in CT screening of lung nodules, and may help to save unnecessary follow-up tests and expenditures.

  9. Automated lung nodule classification following automated nodule detection on CT: A serial approach

    International Nuclear Information System (INIS)

    Armato, Samuel G. III; Altman, Michael B.; Wilkie, Joel; Sone, Shusuke; Li, Feng; Doi, Kunio; Roy, Arunabha S.

    2003-01-01

    We have evaluated the performance of an automated classifier applied to the task of differentiating malignant and benign lung nodules in low-dose helical computed tomography (CT) scans acquired as part of a lung cancer screening program. The nodules classified in this manner were initially identified by our automated lung nodule detection method, so that the output of automated lung nodule detection was used as input to automated lung nodule classification. This study begins to narrow the distinction between the 'detection task' and the 'classification task'. Automated lung nodule detection is based on two- and three-dimensional analyses of the CT image data. Gray-level-thresholding techniques are used to identify initial lung nodule candidates, for which morphological and gray-level features are computed. A rule-based approach is applied to reduce the number of nodule candidates that correspond to non-nodules, and the features of remaining candidates are merged through linear discriminant analysis to obtain final detection results. Automated lung nodule classification merges the features of the lung nodule candidates identified by the detection algorithm that correspond to actual nodules through another linear discriminant classifier to distinguish between malignant and benign nodules. The automated classification method was applied to the computerized detection results obtained from a database of 393 low-dose thoracic CT scans containing 470 confirmed lung nodules (69 malignant and 401 benign nodules). Receiver operating characteristic (ROC) analysis was used to evaluate the ability of the classifier to differentiate between nodule candidates that correspond to malignant nodules and nodule candidates that correspond to benign lesions. The area under the ROC curve for this classification task attained a value of 0.79 during a leave-one-out evaluation

  10. Accuracy of lung nodule volumetry in low-dose CT with iterative reconstruction: an anthropomorphic thoracic phantom study.

    Science.gov (United States)

    Doo, K W; Kang, E-Y; Yong, H S; Woo, O H; Lee, K Y; Oh, Y-W

    2014-09-01

    The purpose of this study was to assess accuracy of lung nodule volumetry in low-dose CT with application of iterative reconstruction (IR) according to nodule size, nodule density and CT tube currents, using artificial lung nodules within an anthropomorphic thoracic phantom. Eight artificial nodules (four diameters: 5, 8, 10 and 12 mm; two CT densities: -630 HU that represents ground-glass nodule and +100 HU that represents solid nodule) were randomly placed inside a thoracic phantom. Scans were performed with tube current-time product to 10, 20, 30 and 50 mAs. Images were reconstructed with IR and filtered back projection (FBP). We compared volume estimates to a reference standard and calculated the absolute percentage error (APE). The APE of all nodules was significantly lower when IR was used than with FBP (7.5 ± 4.7% compared with 9.0 ±6.9%; p volumetry in low-dose CT by application of IR showed reliable accuracy in a phantom study. Lung nodule volumetry can be reliably applicable to all lung nodules including small, ground-glass nodules even in ultra-low-dose CT with application of IR. IR significantly improved the accuracy of lung nodule volumetry compared with FBP particularly for ground-glass (-630 HU) nodules. Volumetry in low-dose CT can be utilized in patient with lung nodule work-up, and IR has benefit for small, ground-glass lung nodules in low-dose CT.

  11. Use of Volumetry for Lung Nodule Management: Theory and Practice

    NARCIS (Netherlands)

    Devaraj, A.; Ginneken, B. van; Nair, A.; Baldwin, D.

    2017-01-01

    A consistent feature of many lung nodule management guidelines is the recommendation to evaluate nodule size by using diameter measurements and electronic calipers. Traditionally, the use of nodule volumetry applications has primarily been reserved for certain lung cancer screening trials rather

  12. Radio-guided thoracoscopic surgery (RGTS) of small pulmonary nodules.

    Science.gov (United States)

    Ambrogi, Marcello Carlo; Melfi, Franca; Zirafa, Carmelina; Lucchi, Marco; De Liperi, Annalisa; Mariani, Giuliano; Fanucchi, Olivia; Mussi, Alfredo

    2012-04-01

    The demand for adequate tissue sampling to determine individual tumor behavior is increasing the number of lung nodule resections, even when the diagnosis is already recognized. Video-assisted thoracic surgery (VATS) is the procedure of choice for diagnosis and treatment of small pulmonary nodules. Difficulties in localizing smaller and deeper nodules have been approached with different techniques. Herein we report our 13-years' experience with radio-guided thoracoscopic resection. Patients with pulmonary nodules smaller than 1 cm and/or deeper than 1 cm, below the visceral pleura, underwent computed tomography (CT)-guided injection of a solution, composed of 0.2 ml (99)Tc-labeled human serum albumin microspheres and 0.1 ml nonionic contrast, into the nodule. During the VATS procedure, an 11-mm-diameter collimated probe connected to a gamma ray detector was introduced to scan the lung surface. The area of major radioactivity, which matched with the area of the nodule, was resected. From 1997 to 2009, 573 patients underwent thoracoscopic resection of small pulmonary nodules, 211 with the radio-guided technique. There were 159 men and 52 women, with an average age of 60.6 years (range = 12-83). The mean duration of the surgical procedure was 41 min (range = 20-100). The procedure was successful in 208/211 cases. Three patients (0.5%) required conversion to a minithoracotomy. The mean length of pleural drainage and hospital stay was 2.3 and 3.7 days, respectively. Histological examination showed 98 benign lesions and 113 malignant lesions (61 metastases and 52 primary lung cancers). This study confirms that radio-guided localization of small pulmonary nodules is a feasible, safe, and quick procedure, with a high rate of success. The spread of the sentinel lymph node technique has increased the availability of technology required for RGTS.

  13. Lung nodules after whole lung radiation

    International Nuclear Information System (INIS)

    Cohen, M.D.; Mirkin, D.L.; Provisor, A.; Hornback, N.B.; Smith, J.A.; Slabaugh, R.D.

    1983-01-01

    It is essential to recognize radiation pneumonitis after whole lung irradiation, or nodular changes in response to chemotherapy, so that such conditions are not mistaken for tumor metastases, causing grave error in patient management and the possibility of further lung damage

  14. Automatic Solitary Lung Nodule Detection in Computed Tomography Images Slices

    Science.gov (United States)

    Sentana, I. W. B.; Jawas, N.; Asri, S. A.

    2018-01-01

    Lung nodule is an early indicator of some lung diseases, including lung cancer. In Computed Tomography (CT) based image, nodule is known as a shape that appears brighter than lung surrounding. This research aim to develop an application that automatically detect lung nodule in CT images. There are some steps in algorithm such as image acquisition and conversion, image binarization, lung segmentation, blob detection, and classification. Data acquisition is a step to taking image slice by slice from the original *.dicom format and then each image slices is converted into *.tif image format. Binarization that tailoring Otsu algorithm, than separated the background and foreground part of each image slices. After removing the background part, the next step is to segment part of the lung only so the nodule can localized easier. Once again Otsu algorithm is use to detect nodule blob in localized lung area. The final step is tailoring Support Vector Machine (SVM) to classify the nodule. The application has succeed detecting near round nodule with a certain threshold of size. Those detecting result shows drawback in part of thresholding size and shape of nodule that need to enhance in the next part of the research. The algorithm also cannot detect nodule that attached to wall and Lung Chanel, since it depend the searching only on colour differences.

  15. Lung cancer - small cell

    Science.gov (United States)

    Cancer - lung - small cell; Small cell lung cancer; SCLC ... About 15% of all lung cancer cases are SCLC. Small cell lung cancer is slightly more common in men than women. Almost all cases of SCLC are ...

  16. Use of Volumetry for Lung Nodule Management: Theory and Practice.

    Science.gov (United States)

    Devaraj, Anand; van Ginneken, Bram; Nair, Arjun; Baldwin, David

    2017-09-01

    A consistent feature of many lung nodule management guidelines is the recommendation to evaluate nodule size by using diameter measurements and electronic calipers. Traditionally, the use of nodule volumetry applications has primarily been reserved for certain lung cancer screening trials rather than clinical practice. However, even before the first nodule management guidelines were published more than a decade ago, research has been ongoing into the use of nodule volumetry as a means of measuring nodule size, and this research has accelerated in recent years. This article aims to provide radiologists with an up-to-date review of the most recent literature on volumetry and volume doubling times in lung nodule management, outlining their benefits and drawbacks. A brief technical review of typical volumetry applications is also provided. © RSNA, 2017.

  17. Improved pulmonary nodule classification utilizing quantitative lung parenchyma features.

    Science.gov (United States)

    Dilger, Samantha K N; Uthoff, Johanna; Judisch, Alexandra; Hammond, Emily; Mott, Sarah L; Smith, Brian J; Newell, John D; Hoffman, Eric A; Sieren, Jessica C

    2015-10-01

    Current computer-aided diagnosis (CAD) models for determining pulmonary nodule malignancy characterize nodule shape, density, and border in computed tomography (CT) data. Analyzing the lung parenchyma surrounding the nodule has been minimally explored. We hypothesize that improved nodule classification is achievable by including features quantified from the surrounding lung tissue. To explore this hypothesis, we have developed expanded quantitative CT feature extraction techniques, including volumetric Laws texture energy measures for the parenchyma and nodule, border descriptors using ray-casting and rubber-band straightening, histogram features characterizing densities, and global lung measurements. Using stepwise forward selection and leave-one-case-out cross-validation, a neural network was used for classification. When applied to 50 nodules (22 malignant and 28 benign) from high-resolution CT scans, 52 features (8 nodule, 39 parenchymal, and 5 global) were statistically significant. Nodule-only features yielded an area under the ROC curve of 0.918 (including nodule size) and 0.872 (excluding nodule size). Performance was improved through inclusion of parenchymal (0.938) and global features (0.932). These results show a trend toward increased performance when the parenchyma is included, coupled with the large number of significant parenchymal features that support our hypothesis: the pulmonary parenchyma is influenced differentially by malignant versus benign nodules, assisting CAD-based nodule characterizations.

  18. Fusobacterium necrophorum presenting as isolated lung nodules

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    Rajiv Sonti

    2015-01-01

    Full Text Available Fusobacterium necrophorum causes Lemierre's syndrome - a dramatic and distinct condition beginning with pharyngitis before proceeding to internal jugular vein septic thrombophlebitis and respiratory tract infection in otherwise healthy individuals. It is rare, but by far the most common pathway to parenchymal lung disease with this organism. Here we describe we a 34 year old healthy lady who was nontoxic without any antecedent illness who presented with lung nodules due to fusobacterium necrophorum as the sole manifestation of disease. Leading diagnostic consideration prior to culture data was pulmonary vasculitis. Identifying her disease process was a somewhat chance occurrence, and it began to resolve prior to antibiotic therapy. Though it would be difficult to recommend keen awareness of this organism given its rarity, it is important to consider that its scope may be broader than traditionally considered.

  19. Vasculature surrounding a nodule: A novel lung cancer biomarker.

    Science.gov (United States)

    Wang, Xiaohua; Leader, Joseph K; Wang, Renwei; Wilson, David; Herman, James; Yuan, Jian-Min; Pu, Jiantao

    2017-12-01

    To investigate whether the vessels surrounding a nodule depicted on non-contrast, low-dose computed tomography (LDCT) can discriminate benign and malignant screen detected nodules. We collected a dataset consisting of LDCT scans acquired on 100 subjects from the Pittsburgh Lung Screening study (PLuSS). Fifty subjects were diagnosed with lung cancer and 50 subjects had suspicious nodules later proven benign. For the lung cancer cases, the location of the malignant nodule in the LDCT scans was known; while for the benign cases, the largest nodule in the LDCT scan was used in the analysis. A computer algorithm was developed to identify surrounding vessels and quantify the number and volume of vessels that were connected or near the nodule. A nonparametric receiver operating characteristic (ROC) analysis was performed based on a single nodule per subject to assess the discriminability of the surrounding vessels to provide a lung cancer diagnosis. Odds ratio (OR) were computed to determine the probability of a nodule being lung cancer based on the vessel features. The areas under the ROC curves (AUCs) for vessel count and vessel volume were 0.722 (95% CI=0.616-0.811, plung cancer group 9.7 (±9.6) compared to the non-lung cancer group 4.0 (±4.3) CONCLUSION: Our preliminary results showed that malignant nodules are often surrounded by more vessels compared to benign nodules, suggesting that the surrounding vessel characteristics could serve as lung cancer biomarker for indeterminate nodules detected during LDCT lung cancer screening using only the information collected during the initial visit. Copyright © 2017 Elsevier B.V. All rights reserved.

  20. System for automatic detection of lung nodules exhibiting growth

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    Novak, Carol L.; Shen, Hong; Odry, Benjamin L.; Ko, Jane P.; Naidich, David P.

    2004-05-01

    Lung nodules that exhibit growth over time are considered highly suspicious for malignancy. We present a completely automated system for detection of growing lung nodules, using initial and follow-up multi-slice CT studies. The system begins with automatic detection of lung nodules in the later CT study, generating a preliminary list of candidate nodules. Next an automatic system for registering locations in two studies matches each candidate in the later study to its corresponding position in the earlier study. Then a method for automatic segmentation of lung nodules is applied to each candidate and its matching location, and the computed volumes are compared. The output of the system is a list of nodule candidates that are new or have exhibited volumetric growth since the previous scan. In a preliminary test of 10 patients examined by two radiologists, the automatic system identified 18 candidates as growing nodules. 7 (39%) of these corresponded to validated nodules or other focal abnormalities that exhibited growth. 4 of the 7 true detections had not been identified by either of the radiologists during their initial examinations of the studies. This technique represents a powerful method of surveillance that may reduce the probability of missing subtle or early malignant disease.

  1. Computerized detection of lung nodules in digital chest radiographs

    International Nuclear Information System (INIS)

    Giger, M.L.; Doi, K.; MacMahon, H.

    1987-01-01

    Detection of cancerous lung nodules in chest radiographs is one of the more important tasks performed by a radiologist. In addition, the ''miss rate'' associated with the radiographic detection of lung nodules is approximately 30%. A computerized scheme that alerts the radiologist to possible locations of lung nodules should allow this number of false-negative diagnoses to be reduced. The authors are developing a computer-aided nodule detection scheme based on a difference image approach. They attempt to eliminate the camouflaging background structure of the normal lung anatomy by creating, from a single-projection chest image, two images: one in which the signal-to-noise ratio (SNR) of the nodule is maximized and another in which that SNR is suppressed while the processed background remains essentially the same. Thus, the difference between these two processed images should consist of the nodule superimposed on a relatively uniform background in which the detection task may be simplified. This difference image approach is fundamentally different from conventional subtraction techniques (e.g., temporal or dual-energy subtraction) in that the two images which are subtracted arise from the same single-projection chest radiograph. Once the difference image is obtained, thresholding is performed along with tests for circularity, size and growth in order to extract the nodules. It should be noted that once an original chest image is input to the computer the nodule detection process is totally automated

  2. Radiographic test phantom for computed tomographic lung nodule analysis

    International Nuclear Information System (INIS)

    Zerhouni, E.A.

    1987-01-01

    This patent describes a method for evaluating a computed tomograph scan of a nodule in a lung of a human or non-human animal. The method comprises generating a computer tomograph of a transverse section of the animal containing lung and nodule tissue, and generating a second computer tomograph of a test phantom comprising a device which simulates the transverse section of the animal. The tissue simulating portions of the device are constructed of materials having radiographic densities substantially identical to those of the corresponding tissue in the simulated transverse section of the animal and have voids therein which simulate, in size and shape, the lung cavities in the transverse section and which contain a test reference nodule constructed of a material of predetermined radiographic density which simulates in size, shape and position within a lung cavity void of the test phantom the nodule in the transverse section of the animal and comparing the respective tomographs

  3. Lung Nodule Detection in CT Images using Neuro Fuzzy Classifier

    Directory of Open Access Journals (Sweden)

    M. Usman Akram

    2013-07-01

    Full Text Available Automated lung cancer detection using computer aided diagnosis (CAD is an important area in clinical applications. As the manual nodule detection is very time consuming and costly so computerized systems can be helpful for this purpose. In this paper, we propose a computerized system for lung nodule detection in CT scan images. The automated system consists of two stages i.e. lung segmentation and enhancement, feature extraction and classification. The segmentation process will result in separating lung tissue from rest of the image, and only the lung tissues under examination are considered as candidate regions for detecting malignant nodules in lung portion. A feature vector for possible abnormal regions is calculated and regions are classified using neuro fuzzy classifier. It is a fully automatic system that does not require any manual intervention and experimental results show the validity of our system.

  4. Lung nodule volumetry: segmentation algorithms within the same software package cannot be used interchangeably.

    NARCIS (Netherlands)

    Ashraf, H.; Hoop, B.J. de; Shaker, S.B.; Dirksen, A.; Bach, K.S.; Hansen, H.; Prokop, M.; Pedersen, J.H.

    2010-01-01

    OBJECTIVE: We examined the reproducibility of lung nodule volumetry software that offers three different volumetry algorithms. METHODS: In a lung cancer screening trial, 188 baseline nodules >5 mm were identified. Including follow-ups, these nodules formed a study-set of 545 nodules. Nodules were

  5. Intelligent Recognition of Lung Nodule Combining Rule-based and C-SVM Classifiers

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    Bin Li

    2011-10-01

    Full Text Available Computer-aided detection(CAD system for lung nodules plays the important role in the diagnosis of lung cancer. In this paper, an improved intelligent recognition method of lung nodule in HRCT combing rule-based and costsensitive support vector machine(C-SVM classifiers is proposed for detecting both solid nodules and ground-glass opacity(GGO nodules(part solid and nonsolid. This method consists of several steps. Firstly, segmentation of regions of interest(ROIs, including pulmonary parenchyma and lung nodule candidates, is a difficult task. On one side, the presence of noise lowers the visibility of low-contrast objects. On the other side, different types of nodules, including small nodules, nodules connecting to vasculature or other structures, part-solid or nonsolid nodules, are complex, noisy, weak edge or difficult to define the boundary. In order to overcome the difficulties of obvious boundary-leak and slow evolvement speed problem in segmentatioin of weak edge, an overall segmentation method is proposed, they are: the lung parenchyma is extracted based on threshold and morphologic segmentation method; the image denoising and enhancing is realized by nonlinear anisotropic diffusion filtering(NADF method;candidate pulmonary nodules are segmented by the improved C-V level set method, in which the segmentation result of EM-based fuzzy threshold method is used as the initial contour of active contour model and a constrained energy term is added into the PDE of level set function. Then, lung nodules are classified by using the intelligent classifiers combining rules and C-SVM. Rule-based classification is first used to remove easily dismissible nonnodule objects, then C-SVM classification are used to further classify nodule candidates and reduce the number of false positive(FP objects. In order to increase the efficiency of SVM, an improved training method is used to train SVM, which uses the grid search method to search the optimal parameters

  6. Intelligent Recognition of Lung Nodule Combining Rule-based and C-SVM Classifiers

    Directory of Open Access Journals (Sweden)

    Bin Li

    2012-02-01

    Full Text Available Computer-aided detection(CAD system for lung nodules plays the important role in the diagnosis of lung cancer. In this paper, an improved intelligent recognition method of lung nodule in HRCT combing rule-based and cost-sensitive support vector machine(C-SVM classifiers is proposed for detecting both solid nodules and ground-glass opacity(GGO nodules(part solid and nonsolid. This method consists of several steps. Firstly, segmentation of regions of interest(ROIs, including pulmonary parenchyma and lung nodule candidates, is a difficult task. On one side, the presence of noise lowers the visibility of low-contrast objects. On the other side, different types of nodules, including small nodules, nodules connecting to vasculature or other structures, part-solid or nonsolid nodules, are complex, noisy, weak edge or difficult to define the boundary. In order to overcome the difficulties of obvious boundary-leak and slow evolvement speed problem in segmentatioin of weak edge, an overall segmentation method is proposed, they are: the lung parenchyma is extracted based on threshold and morphologic segmentation method; the image denoising and enhancing is realized by nonlinear anisotropic diffusion filtering(NADF method; candidate pulmonary nodules are segmented by the improved C-V level set method, in which the segmentation result of EM-based fuzzy threshold method is used as the initial contour of active contour model and a constrained energy term is added into the PDE of level set function. Then, lung nodules are classified by using the intelligent classifiers combining rules and C-SVM. Rule-based classification is first used to remove easily dismissible nonnodule objects, then C-SVM classification are used to further classify nodule candidates and reduce the number of false positive(FP objects. In order to increase the efficiency of SVM, an improved training method is used to train SVM, which uses the grid search method to search the optimal

  7. Digital tomosynthesis for evaluating metastatic lung nodules: nodule visibility, learning curves, and reading times.

    Science.gov (United States)

    Lee, Kyung Hee; Goo, Jin Mo; Lee, Sang Min; Park, Chang Min; Bahn, Young Eun; Kim, Hyungjin; Song, Yong Sub; Hwang, Eui Jin

    2015-01-01

    To evaluate nodule visibility, learning curves, and reading times for digital tomosynthesis (DT). We included 80 patients who underwent computed tomography (CT) and DT before pulmonary metastasectomy. One experienced chest radiologist annotated all visible nodules on thin-section CT scans using computer-aided detection software. Two radiologists used CT as the reference standard and retrospectively graded the visibility of nodules on DT. Nodule detection performance was evaluated in four sessions of 20 cases each by six readers. After each session, readers were unblinded to the DT images by revealing the true-positive markings and were instructed to self-analyze their own misreads. Receiver-operating-characteristic curves were determined. Among 414 nodules on CT, 53.3% (221/414) were visible on DT. The main reason for not seeing a nodule on DT was small size (93.3%, ≤ 5 mm). DT revealed a substantial number of malignant nodules (84.1%, 143/170). The proportion of malignant nodules among visible nodules on DT was significantly higher (64.7%, 143/221) than that on CT (41.1%, 170/414) (p 0.8, and the average detection rate for malignant nodules was 85% (210/246). The inter-session analysis of the AUC showed no significant differences among the readers, and the detection rate for malignant nodules did not differ across sessions. A slight improvement in reading times was observed. Most malignant nodules > 5 mm were visible on DT. As nodule detection performance was high from the initial session, DT may be readily applicable for radiology residents and board-certified radiologists.

  8. Digital tomosynthesis for evaluating metastatic lung nodules: Nodule visibility, learning curves, and reading times

    International Nuclear Information System (INIS)

    Lee, Kyung Hee; Goo, Jin Mo; Lee, Sang Min; Park, Chang Min; Bahn, Young Eun; Kim, Hyung Jin; Song, Yong Sub; Hwang, Eui Jin

    2015-01-01

    To evaluate nodule visibility, learning curves, and reading times for digital tomosynthesis (DT). We included 80 patients who underwent computed tomography (CT) and DT before pulmonary metastasectomy. One experienced chest radiologist annotated all visible nodules on thin-section CT scans using computer-aided detection software. Two radiologists used CT as the reference standard and retrospectively graded the visibility of nodules on DT. Nodule detection performance was evaluated in four sessions of 20 cases each by six readers. After each session, readers were unblinded to the DT images by revealing the true-positive markings and were instructed to self-analyze their own misreads. Receiver-operating-characteristic curves were determined. Among 414 nodules on CT, 53.3% (221/414) were visible on DT. The main reason for not seeing a nodule on DT was small size (93.3%, < or = 5 mm). DT revealed a substantial number of malignant nodules (84.1%, 143/170). The proportion of malignant nodules among visible nodules on DT was significantly higher (64.7%, 143/221) than that on CT (41.1%, 170/414) (p < 0.001). Area under the curve (AUC) values at the initial session were > 0.8, and the average detection rate for malignant nodules was 85% (210/246). The inter-session analysis of the AUC showed no significant differences among the readers, and the detection rate for malignant nodules did not differ across sessions. A slight improvement in reading times was observed. Most malignant nodules > 5 mm were visible on DT. As nodule detection performance was high from the initial session, DT may be readily applicable for radiology residents and board-certified radiologists.

  9. Digital tomosynthesis for evaluating metastatic lung nodules: Nodule visibility, learning curves, and reading times

    Energy Technology Data Exchange (ETDEWEB)

    Lee, Kyung Hee; Goo, Jin Mo; Lee, Sang Min; Park, Chang Min; Bahn, Young Eun; Kim, Hyung Jin; Song, Yong Sub; Hwang, Eui Jin [Dept. of Radiology, Seoul National University College of Medicine, and Institute of Radiation Medicine, Seoul National University Medical Research Center, Seoul (Korea, Republic of)

    2015-04-15

    To evaluate nodule visibility, learning curves, and reading times for digital tomosynthesis (DT). We included 80 patients who underwent computed tomography (CT) and DT before pulmonary metastasectomy. One experienced chest radiologist annotated all visible nodules on thin-section CT scans using computer-aided detection software. Two radiologists used CT as the reference standard and retrospectively graded the visibility of nodules on DT. Nodule detection performance was evaluated in four sessions of 20 cases each by six readers. After each session, readers were unblinded to the DT images by revealing the true-positive markings and were instructed to self-analyze their own misreads. Receiver-operating-characteristic curves were determined. Among 414 nodules on CT, 53.3% (221/414) were visible on DT. The main reason for not seeing a nodule on DT was small size (93.3%, < or = 5 mm). DT revealed a substantial number of malignant nodules (84.1%, 143/170). The proportion of malignant nodules among visible nodules on DT was significantly higher (64.7%, 143/221) than that on CT (41.1%, 170/414) (p < 0.001). Area under the curve (AUC) values at the initial session were > 0.8, and the average detection rate for malignant nodules was 85% (210/246). The inter-session analysis of the AUC showed no significant differences among the readers, and the detection rate for malignant nodules did not differ across sessions. A slight improvement in reading times was observed. Most malignant nodules > 5 mm were visible on DT. As nodule detection performance was high from the initial session, DT may be readily applicable for radiology residents and board-certified radiologists.

  10. The calcified lung nodule: What does it mean?

    Directory of Open Access Journals (Sweden)

    Khan Ali

    2010-01-01

    Full Text Available The aim of this review is to present a pictorial essay emphasizing the various patterns of calcification in pulmonary nodules (PN to aid diagnosis and to discuss the differential diagnosis and the pathogenesis where it is known. The imaging evaluation of PN is based on clinical history, size, distribution and the gross appearance of the nodule as well as feasibility of obtaining a tissue diagnosis. Imaging is instrumental in the management of PN and one should strive not only to identify small malignant tumors with high survival rates but to spare patients with benign PN from undergoing unnecessary surgery. The review emphasizes how to achieve these goals. One of the most reliable imaging features of a benign lesion is a benign pattern of calcification and periodic follow-up with computed tomography showing no growth for 2 years. Calcification in PN is generally considered as a pointer toward a possible benign disease. However, as we show here, calcification in PN as a criterion to determine benign nature is fallacious and can be misleading. The differential considerations of a calcified lesion include calcified granuloma, hamartoma, carcinoid, osteosarcoma, chondrosarcoma and lung metastases or a primary bronchogenic carcinoma among others. We describe and illustrate different patterns of calcification as seen in PN on imaging.

  11. Lung nodule volumetry: segmentation algorithms within the same software package cannot be used interchangeably

    DEFF Research Database (Denmark)

    Ashraf, Haseem; de Hoop, B; Shaker, S B

    2010-01-01

    We examined the reproducibility of lung nodule volumetry software that offers three different volumetry algorithms.......We examined the reproducibility of lung nodule volumetry software that offers three different volumetry algorithms....

  12. Differentiating early malignant lung tumors from inflammatory nodules to minimize the use of video-assisted thoracoscopic surgery or open biopsy to establish a diagnosis

    International Nuclear Information System (INIS)

    Nomori, Hiroaki; Horio, Hirotoshi; Suemasu, Keiichi

    2001-01-01

    To decrease the frequency of video-assisted thoracoscopic surgery (VATS) biopsy being used to diagnose inflammatory nodules, we studied the clinicopathological findings of lung cancers and inflammatory nodules diagnosed by VATS or open-lung biopsy. We studied 46 lung cancers and 47 inflammatory nodules smaller than 30 mm in diameter diagnosed by VATS or open-lung biopsy. While the computed tomography (CT) findings were not significantly different between lung cancers and inflammatory nodules, N1 or N2 lung cancers more frequently showed distinct malignant features on CT than T1N0M0 lung cancers (P<0.05). A review of previous chest X-ray films revealed that those of inflammatory nodules showed new nodules more frequently and nodular enlargement less frequently than those of lung cancer (P<0.01). Of 13 lung cancers that showed nodular enlargement during a mean 15-month period, 12 were T1N0M0. Nondiagnosable small lung nodules, which had few malignant features on CT and had newly appeared on a chest X-ray film, were more likely to be inflammatory nodules than lung cancers; and even if they were lung cancers, the tumor stage was usually T1N0M0. Thus, to decrease the incidence of VATS biopsy being performed for inflammatory nodules, intensive follow-up by CT until slight nodular enlargement becomes evident could be a means of revealing nondiagnosable small lung nodules without distinct malignant findings, except for nodules found to be enlarging on a review of retrospective films. (author)

  13. Volumetry of Artificial Pulmonary Nodules in Ex Vivo Porcine Lungs: Comparison of Semi-automated Volumetry and Radiologists' Performance

    International Nuclear Information System (INIS)

    Jeong, Ju Hyeon; Kim, Jin Hwan; Kim, Song Soo; Jeon, Ho Sang; Lee, Hyun Ju; Park, Noh Hyuck; Cho, Gyu Seong

    2010-01-01

    With the advent of MSCT, the detection rate of small pulmonary nodules is markedly greater. However, there is no definite diagnostic clue to differentiate between malignant and benign nodules, except for the interval growth in small nodule less than 1 cm in diameter. We evaluated the accuracy of computer aided volumetry (CAV) and compared it with 4 radiologists' measurement. Fifteen artificial nodules that were embedded in the ex vivo porcine lung were scanned by MSCT. The diameters and volumes of nodules were independently measured three times, at 5-day intervals, and by four radiologists as well as by CAV. We evaluated the accuracy of the measurements on the basis of the true diameter and volume of the nodules. Using a paired t-test and a Bland-Altman plot, we evaluated whether there was a statistically significant difference between the radiologists' measurements and the CAV. The accuracy of the manual measurements by radiologists revealed a statistically significant difference from the true diameter and volume of the artificial nodules (p 0.01) The results of this study suggest that CAV is an accurate and useful tool to evaluate the volume of pulmonary nodules and can eventually be used to differentiate malignant and benign nodules as well as evaluate the therapeutic response of lung cancer

  14. A computerized scheme for lung nodule detection in multiprojection chest radiography

    International Nuclear Information System (INIS)

    Guo Wei; Li Qiang; Boyce, Sarah J.; McAdams, H. Page; Shiraishi, Junji; Doi, Kunio; Samei, Ehsan

    2012-01-01

    CAD scheme may be attributed to the high noise level in chest radiography, and the small size and low contrast of most nodules. Conclusions: This study indicated that the fusion of correlation information in multiprojection chest radiography can markedly improve the performance of CAD scheme for lung nodule detection.

  15. Lung nodule detection in pediatric chest CT: quantitative relationship between image quality and radiologist performance.

    Science.gov (United States)

    Li, Xiang; Samei, Ehsan; Barnhart, Huiman X; Gaca, Ana Maria; Hollingsworth, Caroline L; Maxfield, Charles M; Carrico, Caroline W T; Colsher, James G; Frush, Donald P

    2011-05-01

    To determine the quantitative relationship between image quality and radiologist performance in detecting small lung nodules in pediatric CT. The study included clinical chest CT images of 30 pediatric patients (0-16 years) scanned at tube currents of 55-180 mA. Calibrated noise addition software was used to simulate cases at three nominal mA settings: 70, 35, and 17.5 mA, resulting in quantum noise of 7-32 Hounsfield Unit (HU). Using a validated nodule simulation technique, lung nodules with diameters of 3-5 mm and peak contrasts of 200-500 HU were inserted into the cases, which were then randomized and rated independently by four experienced pediatric radiologists for nodule presence on a continuous scale from 0 (definitely absent) to 100 (definitely present). The receiver operating characteristic (ROC) data were analyzed to quantify the relationship between diagnostic accuracy (area under the ROC curve, AUC) and image quality (the product of nodule peak contrast and displayed diameter to noise ratio, CDNR display). AUC increased rapidly from 0.70 to 0.87 when CDNR display increased from 60 to 130 mm, followed by a slow increase to 0.94 when CDNR display further increased to 257 mm. For the average nodule diameter (4 mm) and contrast (350 HU), AUC decreased from 0.93 to 0.71 with noise increased from 7 to 28 HU. We quantified the relationship between image quality and the performance of radiologists in detecting lung nodules in pediatric CT. The relationship can guide CT protocol design to achieve the desired diagnostic performance at the lowest radiation dose.

  16. Investigation of lung nodule detectability in low-dose 320-slice computed tomography

    Energy Technology Data Exchange (ETDEWEB)

    Silverman, J. D.; Paul, N. S.; Siewerdsen, J. H. [Institute of Biomaterials and Biomedical Engineering, University of Toronto, Toronto, Ontario M5G 2M9 (Canada); Department of Medical Imaging, Toronto General Hospital, Toronto, Ontario M5G 2C6 (Canada); Institute of Biomaterials and Biomedical Engineering, University of Toronto, Toronto, Ontario M5G 2M9 (Canada); Ontario Cancer Institute, Princess Margaret Hospital, Toronto, Ontario M5G 2M9 (Canada) and Department of Medical Biophysics, University of Toronto, Toronto, Ontario M5G 2M9 (Canada)

    2009-05-15

    Low-dose imaging protocols in chest CT are important in the screening and surveillance of suspicious and indeterminate lung nodules. Techniques that maintain nodule detectability yet permit dose reduction, particularly for large body habitus, were investigated. The objective of this study was to determine the extent to which radiation dose can be minimized while maintaining diagnostic performance through knowledgeable selection of reconstruction techniques. A 320-slice volumetric CT scanner (Aquilion ONE, Toshiba Medical Systems) was used to scan an anthropomorphic phantom at doses ranging from {approx}0.1 mGy up to that typical of low-dose CT (LDCT, {approx}5 mGy) and diagnostic CT ({approx}10 mGy). Radiation dose was measured via Farmer chamber and MOSFET dosimetry. The phantom presented simulated nodules of varying size and contrast within a heterogeneous background, and chest thickness was varied through addition of tissue-equivalent bolus about the chest. Detectability of a small solid lung nodule (3.2 mm diameter, -37 HU, typically the smallest nodule of clinical significance in screening and surveillance) was evaluated as a function of dose, patient size, reconstruction filter, and slice thickness by means of nine-alternative forced-choice (9AFC) observer tests to quantify nodule detectability. For a given reconstruction filter, nodule detectability decreased sharply below a threshold dose level due to increased image noise, especially for large body size. However, nodule detectability could be maintained at lower doses through knowledgeable selection of (smoother) reconstruction filters. For large body habitus, optimal filter selection reduced the dose required for nodule detection by up to a factor of {approx}3 (from {approx}3.3 mGy for sharp filters to {approx}1.0 mGy for the optimal filter). The results indicate that radiation dose can be reduced below the current low-dose (5 mGy) and ultralow-dose (1 mGy) levels with knowledgeable selection of

  17. What to Do with All of These Lung Nodules?

    Directory of Open Access Journals (Sweden)

    Dmitry Rozenberg

    2014-01-01

    Full Text Available Caplan syndrome is a rare entity that is specific to rheumatoid arthritis and presents with multiple, well-defined necrotic nodules in patients with occupational dust exposure. The present report describes a case of Caplan syndrome involving a 71-year-old man with a known diagnosis of seropositive rheumatoid arthritis who presented to the authors’ centre with a five-year history of multiple, bilateral cavitary lung nodules with mild dyspnea on exertion. He was an ex-smoker (30 pack-years and had previously worked with silica. The case highlights the clinical, radiological and pathological features of this syndrome and outlines the importance of considering a broad differential in the management of pulmonary nodules, especially in patients with rheumatoid arthritis.

  18. Radiological and pathological analysis of LDCT screen detected and surgically resected sub-centimetre lung nodules in 44 asymptomatic patients

    International Nuclear Information System (INIS)

    Hu, Xing; Zhao, Jiangmin; Qian, Haishan; Du, Guangyan; Kelly, Margaret; Yang, Hua

    2016-01-01

    .000). The patient’s age, the axial morphology of the lesion, relationship to major vessels or visceral pleura and location within the lung parenchyma were not predictive of the pathologic diagnosis. Only one of the 31 patients with a cancer or pre-cancer nodule was a smoker. ACa, AIS and AAH nodules detected on LDCT included more women (77%) than men in our cohort. Smoking as inclusive criteria for LDCT screening of lung cancer needs to be further evaluated in the Chinese population. The reconstructed nodule shape, density and margin may help radiologists to identify small cancer and pre-cancer nodules from benign conditions

  19. Generation of realistic virtual nodules based on three-dimensional spatial resolution in lung computed tomography: A pilot phantom study.

    Science.gov (United States)

    Narita, Akihiro; Ohkubo, Masaki; Murao, Kohei; Matsumoto, Toru; Wada, Shinichi

    2017-10-01

    The aim of this feasibility study using phantoms was to propose a novel method for obtaining computer-generated realistic virtual nodules in lung computed tomography (CT). In the proposed methodology, pulmonary nodule images obtained with a CT scanner are deconvolved with the point spread function (PSF) in the scan plane and slice sensitivity profile (SSP) measured for the scanner; the resultant images are referred to as nodule-like object functions. Next, by convolving the nodule-like object function with the PSF and SSP of another (target) scanner, the virtual nodule can be generated so that it has the characteristics of the spatial resolution of the target scanner. To validate the methodology, the authors applied physical nodules of 5-, 7- and 10-mm-diameter (uniform spheres) included in a commercial CT test phantom. The nodule-like object functions were calculated from the sphere images obtained with two scanners (Scanner A and Scanner B); these functions were referred to as nodule-like object functions A and B, respectively. From these, virtual nodules were generated based on the spatial resolution of another scanner (Scanner C). By investigating the agreement of the virtual nodules generated from the nodule-like object functions A and B, the equivalence of the nodule-like object functions obtained from different scanners could be assessed. In addition, these virtual nodules were compared with the real (true) sphere images obtained with Scanner C. As a practical validation, five types of laboratory-made physical nodules with various complicated shapes and heterogeneous densities, similar to real lesions, were used. The nodule-like object functions were calculated from the images of these laboratory-made nodules obtained with Scanner A. From them, virtual nodules were generated based on the spatial resolution of Scanner C and compared with the real images of laboratory-made nodules obtained with Scanner C. Good agreement of the virtual nodules generated from

  20. Deep-learning derived features for lung nodule classification with limited datasets

    Science.gov (United States)

    Thammasorn, P.; Wu, W.; Pierce, L. A.; Pipavath, S. N.; Lampe, P. D.; Houghton, A. M.; Haynor, D. R.; Chaovalitwongse, W. A.; Kinahan, P. E.

    2018-02-01

    Only a few percent of indeterminate nodules found in lung CT images are cancer. However, enabling earlier diagnosis is important to avoid invasive procedures or long-time surveillance to those benign nodules. We are evaluating a classification framework using radiomics features derived with a machine learning approach from a small data set of indeterminate CT lung nodule images. We used a retrospective analysis of 194 cases with pulmonary nodules in the CT images with or without contrast enhancement from lung cancer screening clinics. The nodules were contoured by a radiologist and texture features of the lesion were calculated. In addition, sematic features describing shape were categorized. We also explored a Multiband network, a feature derivation path that uses a modified convolutional neural network (CNN) with a Triplet Network. This was trained to create discriminative feature representations useful for variable-sized nodule classification. The diagnostic accuracy was evaluated for multiple machine learning algorithms using texture, shape, and CNN features. In the CT contrast-enhanced group, the texture or semantic shape features yielded an overall diagnostic accuracy of 80%. Use of a standard deep learning network in the framework for feature derivation yielded features that substantially underperformed compared to texture and/or semantic features. However, the proposed Multiband approach of feature derivation produced results similar in diagnostic accuracy to the texture and semantic features. While the Multiband feature derivation approach did not outperform the texture and/or semantic features, its equivalent performance indicates promise for future improvements to increase diagnostic accuracy. Importantly, the Multiband approach adapts readily to different size lesions without interpolation, and performed well with relatively small amount of training data.

  1. Radiofrequency thermal ablation of a metastatic lung nodule

    Energy Technology Data Exchange (ETDEWEB)

    Highland, Adrian M. [Department of Clinical Radiology, Hull Royal Infirmary, Anlaby Road, Hull, HU3 2JZ (United Kingdom); Mack, Paul [Diana Princess of Wales Hospital, Scartho Road, Grimsby, DN33 2BA (United Kingdom); Breen, David J. [Department of Radiology, Southampton University Hospitals, Tremona Road, Southampton, SO16 6YD (United Kingdom)

    2002-07-01

    Pulmonary metastases are a common finding in patients with colonic adenocarcinoma. We report the treatment of a metastatic lung nodule with radiofrequency (RF) ablation under CT guidance. This case illustrates the use of RF ablation in a patient in whom surgical resection was no longer possible and where chemotherapy was unlikely to produce benefit. This technique may offer a viable method of cytoreduction when other treatments have not succeeded. (orig.)

  2. Radiofrequency thermal ablation of a metastatic lung nodule

    International Nuclear Information System (INIS)

    Highland, Adrian M.; Mack, Paul; Breen, David J.

    2002-01-01

    Pulmonary metastases are a common finding in patients with colonic adenocarcinoma. We report the treatment of a metastatic lung nodule with radiofrequency (RF) ablation under CT guidance. This case illustrates the use of RF ablation in a patient in whom surgical resection was no longer possible and where chemotherapy was unlikely to produce benefit. This technique may offer a viable method of cytoreduction when other treatments have not succeeded. (orig.)

  3. The methods for detecting multiple small nodules from 3D chest X-ray CT images

    International Nuclear Information System (INIS)

    Hayase, Yosuke; Mekada, Yoshito; Mori, Kensaku; Toriwaki, Jun-ichiro; Natori, Hiroshi

    2004-01-01

    This paper describes a method for detecting small nodules, whose CT values and diameters are more than -600 Hounsfield unit (H.U.) and 2 mm, from three-dimensional chest X-ray CT images. The proposed method roughly consists of two submodules: initial detection of nodule candidates by discriminating between nodule regions and other regions such as blood vessels or bronchi using a shape feature computed from distance values inside the regions and reduction of false positive (FP) regions by using a minimum directional difference filter called minimum directional difference filter (Min-DD) changing its radius suit to the size of the initial candidates. The performance of the proposed method was evaluated by using seven cases of chest X-ray CT images including six abnormal cases where multiple lung cancers are observed. The experimental results for nodules (361 regions in total) showed that sensitivity and FP regions are 71% and 7.4 regions in average per case. (author)

  4. Ground-Glass Opacity Lung Nodules in the Era of Lung Cancer CT Screening

    DEFF Research Database (Denmark)

    Pedersen, Jesper Holst; Saghir, Zaigham; Wille, Mathilde Marie Winkler

    2016-01-01

    The advent of computed tomography screening for lung cancer will increase the incidence of ground-glass opacity (GGO) nodules detected and referred for diagnostic evaluation and management. GGO nodules remain a diagnostic challenge; therefore, a more systematic approach is necessary to ensure...... that will yield improvements in both diagnosis and treatment. The standard-of-care surgical treatment of early lung cancer is still minimally invasive lobectomy with systematic lymph node dissection. However, recent research has shown that some GGO lesions may be treated with sublobar resections; these findings......, the National Comprehensive Cancer Network, and the British Thoracic Society. In addition, we discuss the management and follow-up of GGO nodules in the light of experience from screening trials. Minimally invasive tissue biopsies and the marking of GGO nodules for surgery are new and rapidly developing fields...

  5. Pulmonary Nodule Management in Lung Cancer Screening: A Pictorial Review of Lung-RADS Version 1.0.

    Science.gov (United States)

    Godoy, Myrna C B; Odisio, Erika G L C; Truong, Mylene T; de Groot, Patricia M; Shroff, Girish S; Erasmus, Jeremy J

    2018-05-01

    The number of screening-detected lung nodules is expected to increase as low-dose computed tomography screening is implemented nationally. Standardized guidelines for image acquisition, interpretation, and screen-detected nodule workup are essential to ensure a high standard of medical care and that lung cancer screening is implemented safely and cost effectively. In this article, we review the current guidelines for pulmonary nodule management in the lung cancer screening setting. Copyright © 2018 Elsevier Inc. All rights reserved.

  6. Difficulties encountered managing nodules detected during a computed tomography lung cancer screening program.

    Science.gov (United States)

    Veronesi, Giulia; Bellomi, Massimo; Scanagatta, Paolo; Preda, Lorenzo; Rampinelli, Cristiano; Guarize, Juliana; Pelosi, Giuseppe; Maisonneuve, Patrick; Leo, Francesco; Solli, Piergiorgio; Masullo, Michele; Spaggiari, Lorenzo

    2008-09-01

    The main challenge of screening a healthy population with low-dose computed tomography is to balance the excessive use of diagnostic procedures with the risk of delayed cancer detection. We evaluated the pitfalls, difficulties, and sources of mistakes in the management of lung nodules detected in volunteers in the Cosmos single-center screening trial. A total of 5201 asymptomatic high-risk volunteers underwent screening with multidetector low-dose computed tomography. Nodules detected at baseline or new nodules at annual screening received repeat low-dose computed tomography at 1 year if less than 5 mm, repeat low-dose computed tomography 3 to 6 months later if between 5 and 8 mm, and fluorodeoxyglucose positron emission tomography if more than 8 mm. Growing nodules at the annual screening received low-dose computed tomography at 6 months and computed tomography-positron emission tomography or surgical biopsy according to doubling time, type, and size. During the first year of screening, 106 patients underwent lung biopsy and 91 lung cancers were identified (70% were stage I). Diagnosis was delayed (false-negative) in 6 patients (stage IIB in 1 patient, stage IIIA in 3 patients, and stage IV in 2 patients), including 2 small cell cancers and 1 central lesion. Surgical biopsy revealed benign disease (false-positives) in 15 cases (14%). Positron emission tomography sensitivity was 88% for prevalent cancers and 70% for cancers diagnosed after first annual screening. No needle biopsy procedures were performed in this cohort of patients. Low-dose computed tomography screening is effective for the early detection of lung cancers, but nodule management remains a challenge. Computed tomography-positron emission tomography is useful at baseline, but its sensitivity decreases significantly the subsequent year. Multidisciplinary management and experience are crucial for minimizing misdiagnoses.

  7. Evaluation of radiographic imaging techniques in lung nodule detection

    International Nuclear Information System (INIS)

    Ho, J.T.; Kruger, R.A.

    1989-01-01

    Dual-energy radiography appears to be the most effective technique to address bone superposition that compromises conventional chest radiography. A dual-energy, single-exposure, film-based technique was compared with a dual-energy, dual-exposure technique and conventional chest radiography in a simulated lung nodule detection study. Observers detected more nodules on images produced by dual-energy techniques than on images produced by conventional chest radiography. The difference between dual-energy and conventional chest radiography is statistically significant and the difference between dual-energy, dual-exposure and single-exposure techniques is statistically insignificant. The single-exposure technique has the potential to replace the dual-exposure technique in future clinical application

  8. A COMPREHENSIVE FRAMEWORK FOR AUTOMATIC DETECTION OF PULMONARY NODULES IN LUNG CT IMAGES

    Directory of Open Access Journals (Sweden)

    Mehdi Alilou

    2014-03-01

    Full Text Available Solitary pulmonary nodules may indicate an early stage of lung cancer. Hence, the early detection of nodules is the most efficient way for saving the lives of patients. The aim of this paper is to present a comprehensive Computer Aided Diagnosis (CADx framework for detection of the lung nodules in computed tomography images. The four major components of the developed framework are lung segmentation, identification of candidate nodules, classification and visualization. The process starts with segmentation of lung regions from the thorax. Then, inside the segmented lung regions, candidate nodules are identified using an approach based on multiple thresholds followed by morphological opening and 3D region growing algorithm. Finally, a combination of a rule-based procedure and support vector machine classifier (SVM is utilized to classify the candidate nodules. The proposed CADx method was validated on CT images of 60 patients, containing the total of 211 nodules, selected from the publicly available Lung Image Database Consortium (LIDC image dataset. Comparing to the other state of the art methods, the proposed framework demonstrated acceptable detection performance (Sensitivity: 0.80; Fp/Scan: 3.9. Furthermore, we visualize a range of anatomical structures including the 3D lung structure and the segmented nodules along with the Maximum Intensity Projection (MIP volume rendering method that will enable the radiologists to accurately and easily estimate the distance between the lung structures and the nodules which are frequently difficult at best to recognize from CT images.

  9. SPECT/CT of lung nodules using 111In-DOTA-c(RGDfK) in a mouse lung carcinogenesis model.

    Science.gov (United States)

    Hayakawa, Takuya; Mutoh, Michihiro; Imai, Toshio; Tsuta, Koji; Yanaka, Akinori; Fujii, Hirofumi; Yoshimoto, Mitsuyoshi

    2013-08-01

    Lung cancer is one of the leading causes of cancer-related deaths worldwide, including Japan. Although computed tomography (CT) can detect small lung lesions such as those appearing as ground glass opacity, it cannot differentiate between malignant and non-malignant lesions. Previously, we have shown that single photon emission computed tomography (SPECT) imaging using (111)In-1,4,7,10-tetraazacyclododecane-N,N',N'',N'''-tetraacetic acid-cyclo-(Arg-Gly-Asp-D-Phe-Lys) (DOTA-c(RGDfK)), an imaging probe of αvβ3 integrin, is useful for the early detection of pancreatic cancer in a hamster pancreatic carcinogenesis model. In this study, we aimed to assess the usefulness of SPECT/CT with (111)In-DOTA-c(RGDfK) for the evaluation of the malignancy of lung cancer. Lung tumors were induced by a single intraperitoneal injection (250 mg/kg) of urethane in male A/J mice. Twenty-six weeks after the urethane treatment, SPECT was performed an hour after injection of (111)In-DOTA-c(RGDfK). Following this, the radioactivity ratios of tumor to normal lung tissue were measured by autoradiography (ARG) in the excised lung samples. We also examined the expression of αvβ3 integrin in mouse and human lung samples. Urethane treatment induced 5 hyperplasias, 41 adenomas and 12 adenocarcinomas in the lungs of 8 A/J mice. SPECT with (111)In-DOTA-c(RGDfK) could clearly visualize lung nodules, though we failed to detect small lung nodules like adenoma and hyperplasias (adenocarcinoma: 66.7%, adenoma: 33.6%, hyperplasia: 0.0%). ARG analysis revealed significant uptake of (111)In-DOTA-c(RGDfK) in all the lesions. Moreover, tumor to normal lung tissue ratios increased along with the progression of carcinogenesis. Histopathological examination using human lung tissue samples revealed clear up-regulation of αvβ3 integrin in well-differentiated adenocarcinoma (Noguchi type B and C) rather than atypical adenomatous hyperplasia. Although there are some limitations in evaluating the malignancy of

  10. Volumetric quantification of lung nodules in CT with iterative reconstruction (ASiR and MBIR)

    Energy Technology Data Exchange (ETDEWEB)

    Chen, Baiyu [Medical Physics Graduate Program, Duke University, Durham, North Carolina 27705 and Carl E. Ravin Advanced Imaging Laboratories, Duke University, Durham, North Carolina 27705 (United States); Barnhart, Huiman [Department of Biostatistics and Bioinformatics, Duke University, Durham, North Carolina 27705 (United States); Richard, Samuel [Carl E. Ravin Advanced Imaging Laboratories, Duke University, Durham, North Carolina 27705 and Department of Radiology, Duke University, Durham, North Carolina 27705 (United States); Robins, Marthony [Medical Physics Graduate Program, Duke University, Durham, North Carolina 27705 (United States); Colsher, James [Department of Radiology, Duke University, Durham, North Carolina 27705 (United States); Samei, Ehsan [Medical Physics Graduate Program, Duke University, Durham, North Carolina 27705 (United States); Carl E. Ravin Advanced Imaging Laboratories, Duke University, Durham, North Carolina 27705 (United States); Department of Radiology, Duke University, Durham, North Carolina 27705 (United States); Department of Physics, Department of Biomedical Engineering, and Department of Electronic and Computer Engineering, Duke University, Durham, North Carolina 27705 (United States)

    2013-11-15

    Purpose: Volume quantifications of lung nodules with multidetector computed tomography (CT) images provide useful information for monitoring nodule developments. The accuracy and precision of the volume quantification, however, can be impacted by imaging and reconstruction parameters. This study aimed to investigate the impact of iterative reconstruction algorithms on the accuracy and precision of volume quantification with dose and slice thickness as additional variables.Methods: Repeated CT images were acquired from an anthropomorphic chest phantom with synthetic nodules (9.5 and 4.8 mm) at six dose levels, and reconstructed with three reconstruction algorithms [filtered backprojection (FBP), adaptive statistical iterative reconstruction (ASiR), and model based iterative reconstruction (MBIR)] into three slice thicknesses. The nodule volumes were measured with two clinical software (A: Lung VCAR, B: iNtuition), and analyzed for accuracy and precision.Results: Precision was found to be generally comparable between FBP and iterative reconstruction with no statistically significant difference noted for different dose levels, slice thickness, and segmentation software. Accuracy was found to be more variable. For large nodules, the accuracy was significantly different between ASiR and FBP for all slice thicknesses with both software, and significantly different between MBIR and FBP for 0.625 mm slice thickness with Software A and for all slice thicknesses with Software B. For small nodules, the accuracy was more similar between FBP and iterative reconstruction, with the exception of ASIR vs FBP at 1.25 mm with Software A and MBIR vs FBP at 0.625 mm with Software A.Conclusions: The systematic difference between the accuracy of FBP and iterative reconstructions highlights the importance of extending current segmentation software to accommodate the image characteristics of iterative reconstructions. In addition, a calibration process may help reduce the dependency of

  11. Volumetric quantification of lung nodules in CT with iterative reconstruction (ASiR and MBIR).

    Science.gov (United States)

    Chen, Baiyu; Barnhart, Huiman; Richard, Samuel; Robins, Marthony; Colsher, James; Samei, Ehsan

    2013-11-01

    Volume quantifications of lung nodules with multidetector computed tomography (CT) images provide useful information for monitoring nodule developments. The accuracy and precision of the volume quantification, however, can be impacted by imaging and reconstruction parameters. This study aimed to investigate the impact of iterative reconstruction algorithms on the accuracy and precision of volume quantification with dose and slice thickness as additional variables. Repeated CT images were acquired from an anthropomorphic chest phantom with synthetic nodules (9.5 and 4.8 mm) at six dose levels, and reconstructed with three reconstruction algorithms [filtered backprojection (FBP), adaptive statistical iterative reconstruction (ASiR), and model based iterative reconstruction (MBIR)] into three slice thicknesses. The nodule volumes were measured with two clinical software (A: Lung VCAR, B: iNtuition), and analyzed for accuracy and precision. Precision was found to be generally comparable between FBP and iterative reconstruction with no statistically significant difference noted for different dose levels, slice thickness, and segmentation software. Accuracy was found to be more variable. For large nodules, the accuracy was significantly different between ASiR and FBP for all slice thicknesses with both software, and significantly different between MBIR and FBP for 0.625 mm slice thickness with Software A and for all slice thicknesses with Software B. For small nodules, the accuracy was more similar between FBP and iterative reconstruction, with the exception of ASIR vs FBP at 1.25 mm with Software A and MBIR vs FBP at 0.625 mm with Software A. The systematic difference between the accuracy of FBP and iterative reconstructions highlights the importance of extending current segmentation software to accommodate the image characteristics of iterative reconstructions. In addition, a calibration process may help reduce the dependency of accuracy on reconstruction algorithms

  12. Volumetric quantification of lung nodules in CT with iterative reconstruction (ASiR and MBIR)

    International Nuclear Information System (INIS)

    Chen, Baiyu; Barnhart, Huiman; Richard, Samuel; Robins, Marthony; Colsher, James; Samei, Ehsan

    2013-01-01

    Purpose: Volume quantifications of lung nodules with multidetector computed tomography (CT) images provide useful information for monitoring nodule developments. The accuracy and precision of the volume quantification, however, can be impacted by imaging and reconstruction parameters. This study aimed to investigate the impact of iterative reconstruction algorithms on the accuracy and precision of volume quantification with dose and slice thickness as additional variables.Methods: Repeated CT images were acquired from an anthropomorphic chest phantom with synthetic nodules (9.5 and 4.8 mm) at six dose levels, and reconstructed with three reconstruction algorithms [filtered backprojection (FBP), adaptive statistical iterative reconstruction (ASiR), and model based iterative reconstruction (MBIR)] into three slice thicknesses. The nodule volumes were measured with two clinical software (A: Lung VCAR, B: iNtuition), and analyzed for accuracy and precision.Results: Precision was found to be generally comparable between FBP and iterative reconstruction with no statistically significant difference noted for different dose levels, slice thickness, and segmentation software. Accuracy was found to be more variable. For large nodules, the accuracy was significantly different between ASiR and FBP for all slice thicknesses with both software, and significantly different between MBIR and FBP for 0.625 mm slice thickness with Software A and for all slice thicknesses with Software B. For small nodules, the accuracy was more similar between FBP and iterative reconstruction, with the exception of ASIR vs FBP at 1.25 mm with Software A and MBIR vs FBP at 0.625 mm with Software A.Conclusions: The systematic difference between the accuracy of FBP and iterative reconstructions highlights the importance of extending current segmentation software to accommodate the image characteristics of iterative reconstructions. In addition, a calibration process may help reduce the dependency of

  13. Volumetry of Artificial Pulmonary Nodules in Ex Vivo Porcine Lungs: Comparison of Semi-automated Volumetry and Radiologists' Performance

    Energy Technology Data Exchange (ETDEWEB)

    Jeong, Ju Hyeon; Kim, Jin Hwan; Kim, Song Soo [Chungnam National University Hospital, Daejeon (Korea, Republic of); Jeon, Ho Sang [Pusan National University Yangsan Hospital, Yangsan (Korea, Republic of); Lee, Hyun Ju [Seoul National University Hospital, Seoul (Korea, Republic of); Park, Noh Hyuck [Kwandong University College of Medicine, Myungji Hospital, Goyang (Korea, Republic of); Cho, Gyu Seong [KAIST, Daejeon (Korea, Republic of)

    2010-10-15

    With the advent of MSCT, the detection rate of small pulmonary nodules is markedly greater. However, there is no definite diagnostic clue to differentiate between malignant and benign nodules, except for the interval growth in small nodule less than 1 cm in diameter. We evaluated the accuracy of computer aided volumetry (CAV) and compared it with 4 radiologists' measurement. Fifteen artificial nodules that were embedded in the ex vivo porcine lung were scanned by MSCT. The diameters and volumes of nodules were independently measured three times, at 5-day intervals, and by four radiologists as well as by CAV. We evaluated the accuracy of the measurements on the basis of the true diameter and volume of the nodules. Using a paired t-test and a Bland-Altman plot, we evaluated whether there was a statistically significant difference between the radiologists' measurements and the CAV. The accuracy of the manual measurements by radiologists revealed a statistically significant difference from the true diameter and volume of the artificial nodules (p<0.01). Conversely, the accuracy of CAV did not show a statistically significant difference with the true nodule diameter and volume (p>0.01) The results of this study suggest that CAV is an accurate and useful tool to evaluate the volume of pulmonary nodules and can eventually be used to differentiate malignant and benign nodules as well as evaluate the therapeutic response of lung cancer.

  14. Computer-aided detection of lung nodules in digital chest radiographs

    International Nuclear Information System (INIS)

    Giger, M.L.; Doi, K.; MacMahon, H.M.

    1986-01-01

    The authors are developing an automated method to detect lung nodules by eliminating the ''camouflaging: effect of the lung background. In order to increase the conspicuity of the nodules, we created, from a single chest radiograph, two images: one in which the signal-to-noise ratio (S/N) of the nodule is maximized and another in which that S/N is suppressed. The difference between these two processed images was subjected to feature-extraction technique in order to isolate the nodules. The detection accuracy of the computer-aided detection scheme, as compared with unaided radiologists' performance, was determined using receiver operating characteristic curve analysis

  15. CT-guided localization of small pulmonary nodules using adjacent microcoil implantation prior to video-assisted thoracoscopic surgical resection

    Energy Technology Data Exchange (ETDEWEB)

    Su, Tian-Hao; Jin, Long; He, Wen [Capital Medical University, Department of Radiology, Beijing Friendship Hospital, Beijing (China); Fan, Yue-Feng [Xiamen University, Department of Interventional Therapy, The First Affiliated Hospital, Xiamen, Fujian (China); Hu, Li-Bao [Peking University People' s Hospital, Department of Radiology, Beijing (China)

    2015-09-15

    To describe and assess the localization of small peripheral pulmonary nodules prior to video-assisted thoracoscopic surgical (VATS) resection using the implantation of microcoils. Ninety-two patients with 101 pulmonary nodules underwent computed tomography (CT)-guided implantation of microcoils proximal to each nodule. Patients were randomly assigned to undergo entire microcoil or leaving-microcoil-end implantations. The complications and efficacy of the two implantation methods were evaluated. VATS resection of lung tissue containing each pulmonary lesion and microcoil were performed in the direction of the microcoil marker. Histopathological analysis was performed for the resected pulmonary lesions. CT-guided microcoil implantation was successful in 99/101 cases, and the placement of microcoils within 1 cm of the nodules was not disruptive. There was no difference in the complications and efficacy associated with the entire implantation method (performed for 51/99 nodules) versus the leaving-microcoil-end implantation method (performed for 48/99 nodules). All nodules were successfully removed using VATS resection. Asymptomatic pneumothorax occurred in 16 patients and mild pulmonary haemorrhage occurred in nine patients. However, none of these patients required further surgical treatment. Preoperative localization of small pulmonary nodules using a refined percutaneous microcoil implantation method was found to be safe and useful prior to VATS resection. (orig.)

  16. Positron emission tomography of incidentally detected small pulmonary nodules

    DEFF Research Database (Denmark)

    Fischer, B M; Mortensen, J; Dirksen, A

    2004-01-01

    The aim of this study was to assess the value of fluorodeoxyglucose positron emission tomography (FDG PET) imaging of small pulmonary nodules incidentally detected by spiral computed tomography (CT) in a high-risk population. Ten patients (five females, five males, aged 54-72 years) were recruited...

  17. Comparison of digital tomosynthesis and computed tomography for lung nodule detection in SOS screening program.

    Science.gov (United States)

    Grosso, Maurizio; Priotto, Roberto; Ghirardo, Donatella; Talenti, Alberto; Roberto, Emanuele; Bertolaccini, Luca; Terzi, Alberto; Chauvie, Stéphane

    2017-08-01

    To compare the lung nodules' detection of digital tomosynthesis (DTS) and computed tomography (CT) in the context of the SOS (Studio OSservazionale) prospective screening program for lung cancer detection. One hundred and thirty-two of the 1843 subjects enrolled in the SOS study underwent CT because non-calcified nodules with diameters larger than 5 mm and/or multiple nodules were present in DTS. Two expert radiologists reviewed the exams classifying the nodules based on their radiological appearance and their dimension. LUNG-RADS classification was applied to compare receiver operator characteristics curve between CT and DTS with respect to final diagnosis. CT was used as gold standard. DTS and CT detected 208 and 179 nodules in the 132 subjects, respectively. Of these 208 nodules, 189 (91%) were solid, partially solid, and ground glass opacity. CT confirmed 140/189 (74%) of these nodules but found 4 nodules that were not detected by DTS. DTS and CT were concordant in 62% of the cases applying the 5-point LUNG-RADS scale. The concordance rose to 86% on a suspicious/non-suspicious binary scale. The areas under the curve in receiver operator characteristics were 0.89 (95% CI 0.83-0.94) and 0.80 (95% CI 0.72-0.89) for CT and DTS, respectively. The mean effective dose was 0.09 ± 0.04 mSv for DTS and 4.90 ± 1.20 mSv for CT. The use of a common classification for nodule detection in DTS and CT helps in comparing the two technologies. DTS detected and correctly classified 74% of the nodules seen by CT but lost 4 nodules identified by CT. Concordance between DTS and CT rose to 86% of the nodules when considering LUNG-RADS on a binary scale.

  18. Evaluation of an improved method of simulating lung nodules in chest tomosynthesis

    International Nuclear Information System (INIS)

    Svalkvist, Angelica; Allansdotter Johnsson, Aase; Vikgren, Jenny

    2012-01-01

    Background Simulated pathology is a valuable complement to clinical images in studies aiming at evaluating an imaging technique. In order for a study using simulated pathology to be valid, it is important that the simulated pathology in a realistic way reflect the characteristics of real pathology. Purpose To perform a thorough evaluation of a nodule simulation method for chest tomosynthesis, comparing the detection rate and appearance of the artificial nodules with those of real nodules in an observer performance experiment. Material and Methods A cohort consisting of 64 patients, 38 patients with a total of 129 identified pulmonary nodules and 26 patients without identified pulmonary nodules, was used in the study. Simulated nodules, matching the real clinically found pulmonary nodules by size, attenuation, and location, were created and randomly inserted into the tomosynthesis section images of the patients. Three thoracic radiologists and one radiology resident reviewed the images in an observer performance study divided into two parts. The first part included nodule detection and the second part included rating of the visual appearance of the nodules. The results were evaluated using a modified receiver-operating characteristic (ROC) analysis. Results The sensitivities for real and simulated nodules were comparable, as the area under the modified ROC curve (AUC) was close to 0.5 for all observers (range, 0.43-0.55). Even though the ratings of visual appearance for real and simulated nodules overlapped considerably, the statistical analysis revealed that the observers to were able to separate simulated nodules from real nodules (AUC values range 0.70-0.74). Conclusion The simulation method can be used to create artificial lung nodules that have similar detectability as real nodules in chest tomosynthesis, although experienced thoracic radiologists may be able to distinguish them from real nodules

  19. Lung nodule volumetry: segmentation algorithms within the same software package cannot be used interchangeably

    Energy Technology Data Exchange (ETDEWEB)

    Ashraf, H.; Bach, K.S.; Hansen, H. [Copenhagen University, Department of Radiology, Gentofte Hospital, Hellerup (Denmark); Hoop, B. de [University Medical Centre Utrecht, Department of Radiology, Utrecht (Netherlands); Shaker, S.B.; Dirksen, A. [Copenhagen University, Department of Respiratory Medicine, Gentofte Hospital, Hellerup (Denmark); Prokop, M. [University Medical Centre Utrecht, Department of Radiology, Utrecht (Netherlands); Radboud University Nijmegen, Department of Radiology, Nijmegen (Netherlands); Pedersen, J.H. [Copenhagen University, Department of Cardiothoracic Surgery RT, Rigshospitalet, Copenhagen (Denmark)

    2010-08-15

    We examined the reproducibility of lung nodule volumetry software that offers three different volumetry algorithms. In a lung cancer screening trial, 188 baseline nodules >5 mm were identified. Including follow-ups, these nodules formed a study-set of 545 nodules. Nodules were independently double read by two readers using commercially available volumetry software. The software offers readers three different analysing algorithms. We compared the inter-observer variability of nodule volumetry when the readers used the same and different algorithms. Both readers were able to correctly segment and measure 72% of nodules. In 80% of these cases, the readers chose the same algorithm. When readers used the same algorithm, exactly the same volume was measured in 50% of readings and a difference of >25% was observed in 4%. When the readers used different algorithms, 83% of measurements showed a difference of >25%. Modern volumetric software failed to correctly segment a high number of screen detected nodules. While choosing a different algorithm can yield better segmentation of a lung nodule, reproducibility of volumetric measurements deteriorates substantially when different algorithms were used. It is crucial even in the same software package to choose identical parameters for follow-up. (orig.)

  20. Lung nodule volumetry: segmentation algorithms within the same software package cannot be used interchangeably

    International Nuclear Information System (INIS)

    Ashraf, H.; Bach, K.S.; Hansen, H.; Hoop, B. de; Shaker, S.B.; Dirksen, A.; Prokop, M.; Pedersen, J.H.

    2010-01-01

    We examined the reproducibility of lung nodule volumetry software that offers three different volumetry algorithms. In a lung cancer screening trial, 188 baseline nodules >5 mm were identified. Including follow-ups, these nodules formed a study-set of 545 nodules. Nodules were independently double read by two readers using commercially available volumetry software. The software offers readers three different analysing algorithms. We compared the inter-observer variability of nodule volumetry when the readers used the same and different algorithms. Both readers were able to correctly segment and measure 72% of nodules. In 80% of these cases, the readers chose the same algorithm. When readers used the same algorithm, exactly the same volume was measured in 50% of readings and a difference of >25% was observed in 4%. When the readers used different algorithms, 83% of measurements showed a difference of >25%. Modern volumetric software failed to correctly segment a high number of screen detected nodules. While choosing a different algorithm can yield better segmentation of a lung nodule, reproducibility of volumetric measurements deteriorates substantially when different algorithms were used. It is crucial even in the same software package to choose identical parameters for follow-up. (orig.)

  1. Computer-aided detection of lung nodules on chest CT: issues to be solved before clinical use

    International Nuclear Information System (INIS)

    Goo, Jin Mo

    2005-01-01

    Given the increasing resolution of modern CT scanners, and the requirements for large-scale lung-screening examinations and diagnostic studies, there is an increased need for the accurate and reproducible analysis of the large number of images. Nodule detection is one of the main challenges of CT imaging, as they can be missed due to their small size, low relative contrast, or because they are located in an area with complex anatomy. Recent developments in computer-aided diagnosis (CAD) schemes are expected to aid radiologists in various tasks of chest imaging. In this era of multidetector row CT, the thoracic applications of greatest interest include the detection and volume measurement of lung nodules (1-7). Technology for CAD as applied to lung nodule detection on chest CT has been approved by the Food and Drug Administration and is currently commercially available. The article by Lee et al. (5) in this issue of the Korean Journal of Radiology is one of the few studies to examine the influence of a commercially available CAD system on the detection of lung nodules. In this study, some additional nodules were detected with the help of a CAD system, but at the expense of increased false positivity. The nodule detection rate of the CAD system in this study was lower than that achieved by radiologist, and the authors insist that the CAD system should be improved further. Compared to the use of CAD on mammograms, CAD evaluations of chest CTs remain limited to the laboratory setting. In this field, apart from the issues of detection rate and false positive detections, many obstacles must be overcome before CAD can be used in a true clinical reading environment. In this editorial, I will list some of these issues, but I emphasize now that I believe these issues will be solved by improved CAD versions in the near future

  2. 68Ga-DOTATATE PET/CT imaging of indeterminate pulmonary nodules and lung cancer.

    Directory of Open Access Journals (Sweden)

    Ronald Walker

    Full Text Available 18F-FDG PET/CT is widely used to evaluate indeterminate pulmonary nodules (IPNs. False positive results occur, especially from active granulomatous nodules. A PET-based imaging agent with superior specificity to 18F-FDG for IPNs, is badly needed, especially in areas of endemic granulomatous nodules. Somatostatin receptors (SSTR are expressed in many malignant cells including small cell and non-small cell lung cancers (NSCLCs. 68Ga-DOTATATE, a positron emitter labeled somatostatin analog, combined with PET/CT imaging, may improve the diagnosis of IPNs over 18F-FDG by reducing false positives. Our study purpose was to test this hypothesis in our region with high endemic granulomatous IPNs.We prospectively performed 68Ga-DOTATATE PET/CT and 18F-FDG PET/CT scans in the same 30 patients with newly diagnosed, treatment-naïve lung cancer (N = 14 or IPNs (N = 15 and one metastatic nodule. 68Ga-DOTATATE SUVmax levels at or above 1.5 were considered likely malignant. We analyzed the scan results, correlating with ultimate diagnosis via biopsy or 2-year chest CT follow-up. We also correlated 68Ga-DOTATATE uptake with immunohistochemical (IHC staining for SSTR subtype 2A (SSTR2A in pathological specimens.We analyzed 31 lesions in 30 individuals, with 14 (45% being non-neuroendocrine lung cancers and 1 (3% being metastatic disease. McNemar's result comparing the two radiopharmaceuticals (p = 0.65 indicates that their accuracy of diagnosis in this indication are equivalent. 68Ga-DOTATATE was more specific (94% compared to 81% and less sensitive 73% compared to 93% than 18F-FDG. 68Ga-DOTATATE uptake correlated with SSTR2A expression in tumor stroma determined by immunohistochemical (IHC staining in 5 of 9 (55% NSCLCs.68Ga-DOTATATE and 18F-FDG PET/CT had equivalent accuracy in the diagnosis of non-neuroendocrine lung cancer and 68Ga-DOTATATE was more specific than 18F-FDG for the diagnosis of IPNs. IHC staining for SSTR2A receptor expression correlated with

  3. Computer-aided diagnosis of lung cancer: the effect of training data sets on classification accuracy of lung nodules

    Science.gov (United States)

    Gong, Jing; Liu, Ji-Yu; Sun, Xi-Wen; Zheng, Bin; Nie, Sheng-Dong

    2018-02-01

    This study aims to develop a computer-aided diagnosis (CADx) scheme for classification between malignant and benign lung nodules, and also assess whether CADx performance changes in detecting nodules associated with early and advanced stage lung cancer. The study involves 243 biopsy-confirmed pulmonary nodules. Among them, 76 are benign, 81 are stage I and 86 are stage III malignant nodules. The cases are separated into three data sets involving: (1) all nodules, (2) benign and stage I malignant nodules, and (3) benign and stage III malignant nodules. A CADx scheme is applied to segment lung nodules depicted on computed tomography images and we initially computed 66 3D image features. Then, three machine learning models namely, a support vector machine, naïve Bayes classifier and linear discriminant analysis, are separately trained and tested by using three data sets and a leave-one-case-out cross-validation method embedded with a Relief-F feature selection algorithm. When separately using three data sets to train and test three classifiers, the average areas under receiver operating characteristic curves (AUC) are 0.94, 0.90 and 0.99, respectively. When using the classifiers trained using data sets with all nodules, average AUC values are 0.88 and 0.99 for detecting early and advanced stage nodules, respectively. AUC values computed from three classifiers trained using the same data set are consistent without statistically significant difference (p  >  0.05). This study demonstrates (1) the feasibility of applying a CADx scheme to accurately distinguish between benign and malignant lung nodules, and (2) a positive trend between CADx performance and cancer progression stage. Thus, in order to increase CADx performance in detecting subtle and early cancer, training data sets should include more diverse early stage cancer cases.

  4. Computer-aided classification of lung nodules on computed tomography images via deep learning technique

    Directory of Open Access Journals (Sweden)

    Hua KL

    2015-08-01

    Full Text Available Kai-Lung Hua,1 Che-Hao Hsu,1 Shintami Chusnul Hidayati,1 Wen-Huang Cheng,2 Yu-Jen Chen3 1Department of Computer Science and Information Engineering, National Taiwan University of Science and Technology, 2Research Center for Information Technology Innovation, Academia Sinica, 3Department of Radiation Oncology, MacKay Memorial Hospital, Taipei, Taiwan Abstract: Lung cancer has a poor prognosis when not diagnosed early and unresectable lesions are present. The management of small lung nodules noted on computed tomography scan is controversial due to uncertain tumor characteristics. A conventional computer-aided diagnosis (CAD scheme requires several image processing and pattern recognition steps to accomplish a quantitative tumor differentiation result. In such an ad hoc image analysis pipeline, every step depends heavily on the performance of the previous step. Accordingly, tuning of classification performance in a conventional CAD scheme is very complicated and arduous. Deep learning techniques, on the other hand, have the intrinsic advantage of an automatic exploitation feature and tuning of performance in a seamless fashion. In this study, we attempted to simplify the image analysis pipeline of conventional CAD with deep learning techniques. Specifically, we introduced models of a deep belief network and a convolutional neural network in the context of nodule classification in computed tomography images. Two baseline methods with feature computing steps were implemented for comparison. The experimental results suggest that deep learning methods could achieve better discriminative results and hold promise in the CAD application domain. Keywords: nodule classification, deep learning, deep belief network, convolutional neural network

  5. Incidentally detected lung nodules: clinical predictors of adherence to fleischner society surveillance guidelines.

    LENUS (Irish Health Repository)

    Ridge, Carole A

    2014-02-28

    The objective of this study was to determine adherence to incidentally detected lung nodule computed tomographic (CT) surveillance recommendations and identify demographic and clinical factors that increase the likelihood of CT surveillance.

  6. General Information about Small Cell Lung Cancer

    Science.gov (United States)

    ... Lung Cancer Prevention Lung Cancer Screening Research Small Cell Lung Cancer Treatment (PDQ®)–Patient Version General Information About Small Cell Lung Cancer Go to Health Professional Version Key Points Small ...

  7. Stages of Small Cell Lung Cancer

    Science.gov (United States)

    ... Lung Cancer Prevention Lung Cancer Screening Research Small Cell Lung Cancer Treatment (PDQ®)–Patient Version General Information About Small Cell Lung Cancer Go to Health Professional Version Key Points Small ...

  8. Towards automatic pulmonary nodule management in lung cancer screening with deep learning.

    Science.gov (United States)

    Ciompi, Francesco; Chung, Kaman; van Riel, Sarah J; Setio, Arnaud Arindra Adiyoso; Gerke, Paul K; Jacobs, Colin; Scholten, Ernst Th; Schaefer-Prokop, Cornelia; Wille, Mathilde M W; Marchianò, Alfonso; Pastorino, Ugo; Prokop, Mathias; van Ginneken, Bram

    2017-04-19

    The introduction of lung cancer screening programs will produce an unprecedented amount of chest CT scans in the near future, which radiologists will have to read in order to decide on a patient follow-up strategy. According to the current guidelines, the workup of screen-detected nodules strongly relies on nodule size and nodule type. In this paper, we present a deep learning system based on multi-stream multi-scale convolutional networks, which automatically classifies all nodule types relevant for nodule workup. The system processes raw CT data containing a nodule without the need for any additional information such as nodule segmentation or nodule size and learns a representation of 3D data by analyzing an arbitrary number of 2D views of a given nodule. The deep learning system was trained with data from the Italian MILD screening trial and validated on an independent set of data from the Danish DLCST screening trial. We analyze the advantage of processing nodules at multiple scales with a multi-stream convolutional network architecture, and we show that the proposed deep learning system achieves performance at classifying nodule type that surpasses the one of classical machine learning approaches and is within the inter-observer variability among four experienced human observers.

  9. Characteristic CT Findings After Percutaneous Cryoablation Treatment of Malignant Lung Nodules.

    Science.gov (United States)

    Chaudhry, Ammar; Grechushkin, Vadim; Hoshmand, Mahsa; Kim, Choo Won; Pena, Andres; Huston, Brett; Chaya, Yair; Bilfinger, Thomas; Moore, William

    2015-10-01

    Assess computed tomography (CT) imaging characteristics after percutaneous cryotherapy for lung cancer.A retrospective IRB-approved analysis of 40 patients who underwent nonsurgical treatment for primary stage 1 lung cancer performed from January 2007 to March 2011 was included in this study. All procedures were performed using general anesthesia and CT guidance. Follow-up imaging with CT of the chest was obtained at 1 month, 3 months, 6 months, and 12 months postprocedure to evaluate the ablated lung nodule. Nodule surface area, density (in Hounsfield units), and presence or absence of cavitations were recorded. In addition, the degree of nodule enhancement was also recorded. Patients who were unable to obtain the aforementioned follow-up were excluded from the study.Thirty-six patients underwent percutaneous cryoablation with men to women ratio of 75% with mean age for men 74.6 and mean age for women 74.3 years of age. The average nodule surface area preablation and postcryoablation at 1-, 3-, 6-, and 12-month follow-ups were 2.99, 7.86, 3.89, 3.18 and 3.07[REPLACEMENT CHARACTER]cm, respectively. The average precontrast nodule density before cryoablation was 8.9 and average precontrast nodule density postprocedure at 1, 3, 6, and 12 months follow-ups were 8.5, -5.9, -9.4, and -3.8 HU, respectively. There is increased attenuation of lung nodules over time with an average postcontrast enhancement of 11.4, 18.5, 16.1, and 25.7 HU at the aforementioned time intervals. Cavitations occurred in the cryoablation zone in 53% (19/36) of patients. 80.6% (29/36) of the cavitations in the cryoablation zone resolved within 12 months. Four patients (11%) had recurrence of tumor at the site of cryoablation and none of the patients had satellite or distant metastasis.Our study shows that patients who underwent cryotherapy for lung nodules treatment had characteristic changes on follow-up CT including. The surface area of the nodule increases at the 1-month follow-up with

  10. Detection of lung nodules with low-dose spiral CT: comparison with conventional dose CT

    International Nuclear Information System (INIS)

    Zhu Tianzhao; Tang Guangjian; Jiang Xuexiang

    2004-01-01

    Objective: To investigate the effect of reducing scan dose on the lung nodules detection rate by scanning a lung nodule model at low dose and conventional dose. Methods: The lung and the thoracic cage were simulated by using a cyst filled with water surrounded by a roll bandage. Flour, butter, and paraffin wax were mixed together by a certain ratio to simulate lung nodules of 10 mm and 5 mm in diameter with the CT values ranging from -10 to 50 HU. Conventional-dose scan (240 mA, 140 kV) and low-dose scan of three different levels (43 mA, 140 kV; 50 mA, 120 kV; 75 mA, 80 kV) together with three different pitches (1.0, 1.5, and 2.0) were performed. The images of the simulated nodules were combined with the CT images of a normal adult's upper, middle, and inferior lung. Three radiologists read the images and the number of the nodules they detected including both the real ones and the false-positive ones was calculated to investigate weather there was any difference among different doses, pitch groups, and different locations. Results: The detection rate of the 10 mm and 5 mm nodules was 100% and 89.6% respectively by the low-dose scan. There was no difference between low-dose and conventional-dose CT (χ 2 =0.6907, P>0.70). The detection rate of 5 mm nodules declined when large pitch was used. Conclusion: The detection rates of 10 mm and 5 mm nodules had no difference between low-dose CT and conventional-dose CT. As the pitch augmented, the detection rate for the nodules declined

  11. Ant Colony Optimization Approaches to Clustering of Lung Nodules from CT Images

    Directory of Open Access Journals (Sweden)

    Ravichandran C. Gopalakrishnan

    2014-01-01

    Full Text Available Lung cancer is becoming a threat to mankind. Applying machine learning algorithms for detection and segmentation of irregular shaped lung nodules remains a remarkable milestone in CT scan image analysis research. In this paper, we apply ACO algorithm for lung nodule detection. We have compared the performance against three other algorithms, namely, Otsu algorithm, watershed algorithm, and global region based segmentation. In addition, we suggest a novel approach which involves variations of ACO, namely, refined ACO, logical ACO, and variant ACO. Variant ACO shows better reduction in false positives. In addition we propose black circular neighborhood approach to detect nodule centers from the edge detected image. Genetic algorithm based clustering is performed to cluster the nodules based on intensity, shape, and size. The performance of the overall approach is compared with hierarchical clustering to establish the improvisation in the proposed approach.

  12. Lung cancer - non-small cell

    Science.gov (United States)

    Cancer - lung - non-small cell; Non-small cell lung cancer; NSCLC; Adenocarcinoma - lung; Squamous cell carcinoma - lung ... Research shows that smoking marijuana may help cancer cells grow. But there is no direct link between ...

  13. Accuracy of lung nodule density on HRCT: analysis by PSF-based image simulation.

    Science.gov (United States)

    Ohno, Ken; Ohkubo, Masaki; Marasinghe, Janaka C; Murao, Kohei; Matsumoto, Toru; Wada, Shinichi

    2012-11-08

    A computed tomography (CT) image simulation technique based on the point spread function (PSF) was applied to analyze the accuracy of CT-based clinical evaluations of lung nodule density. The PSF of the CT system was measured and used to perform the lung nodule image simulation. Then, the simulated image was resampled at intervals equal to the pixel size and the slice interval found in clinical high-resolution CT (HRCT) images. On those images, the nodule density was measured by placing a region of interest (ROI) commonly used for routine clinical practice, and comparing the measured value with the true value (a known density of object function used in the image simulation). It was quantitatively determined that the measured nodule density depended on the nodule diameter and the image reconstruction parameters (kernel and slice thickness). In addition, the measured density fluctuated, depending on the offset between the nodule center and the image voxel center. This fluctuation was reduced by decreasing the slice interval (i.e., with the use of overlapping reconstruction), leading to a stable density evaluation. Our proposed method of PSF-based image simulation accompanied with resampling enables a quantitative analysis of the accuracy of CT-based evaluations of lung nodule density. These results could potentially reveal clinical misreadings in diagnosis, and lead to more accurate and precise density evaluations. They would also be of value for determining the optimum scan and reconstruction parameters, such as image reconstruction kernels and slice thicknesses/intervals.

  14. Sublobar resection is equivalent to lobectomy for clinical stage 1A lung cancer in solid nodules.

    Science.gov (United States)

    Altorki, Nasser K; Yip, Rowena; Hanaoka, Takaomi; Bauer, Thomas; Aye, Ralph; Kohman, Leslie; Sheppard, Barry; Thurer, Richard; Andaz, Shahriyour; Smith, Michael; Mayfield, William; Grannis, Fred; Korst, Robert; Pass, Harvey; Straznicka, Michaela; Flores, Raja; Henschke, Claudia I

    2014-02-01

    A single randomized trial established lobectomy as the standard of care for the surgical treatment of early-stage non-small cell lung cancer. Recent advances in imaging/staging modalities and detection of smaller tumors have once again rekindled interest in sublobar resection for early-stage disease. The objective of this study was to compare lung cancer survival in patients with non-small cell lung cancer with a diameter of 30 mm or less with clinical stage 1 disease who underwent lobectomy or sublobar resection. We identified 347 patients diagnosed with lung cancer who underwent lobectomy (n = 294) or sublobar resection (n = 53) for non-small cell lung cancer manifesting as a solid nodule in the International Early Lung Cancer Action Program from 1993 to 2011. Differences in the distribution of the presurgical covariates between sublobar resection and lobectomy were assessed using unadjusted P values determined by logistic regression analysis. Propensity scoring was performed using the same covariates. Differences in the distribution of the same covariates between sublobar resection and lobectomy were assessed using adjusted P values determined by logistic regression analysis with adjustment for the propensity scores. Lung cancer-specific survival was determined by the Kaplan-Meier method. Cox survival regression analysis was used to compare sublobar resection with lobectomy, adjusted for the propensity scores, surgical, and pathology findings, when adjusted and stratified by propensity quintiles. Among 347 patients, 10-year Kaplan-Meier for 53 patients treated by sublobar resection compared with 294 patients treated by lobectomy was 85% (95% confidence interval, 80-91) versus 86% (confidence interval, 75-96) (P = .86). Cox survival analysis showed no significant difference between sublobar resection and lobectomy when adjusted for propensity scores or when using propensity quintiles (P = .62 and P = .79, respectively). For those with cancers 20 mm or less in

  15. Early detection of lung cancer from CT images: nodule segmentation and classification using deep learning

    Science.gov (United States)

    Sharma, Manu; Bhatt, Jignesh S.; Joshi, Manjunath V.

    2018-04-01

    Lung cancer is one of the most abundant causes of the cancerous deaths worldwide. It has low survival rate mainly due to the late diagnosis. With the hardware advancements in computed tomography (CT) technology, it is now possible to capture the high resolution images of lung region. However, it needs to be augmented by efficient algorithms to detect the lung cancer in the earlier stages using the acquired CT images. To this end, we propose a two-step algorithm for early detection of lung cancer. Given the CT image, we first extract the patch from the center location of the nodule and segment the lung nodule region. We propose to use Otsu method followed by morphological operations for the segmentation. This step enables accurate segmentation due to the use of data-driven threshold. Unlike other methods, we perform the segmentation without using the complete contour information of the nodule. In the second step, a deep convolutional neural network (CNN) is used for the better classification (malignant or benign) of the nodule present in the segmented patch. Accurate segmentation of even a tiny nodule followed by better classification using deep CNN enables the early detection of lung cancer. Experiments have been conducted using 6306 CT images of LIDC-IDRI database. We achieved the test accuracy of 84.13%, with the sensitivity and specificity of 91.69% and 73.16%, respectively, clearly outperforming the state-of-the-art algorithms.

  16. Computer-Aided Detection of Malignant Lung Nodules on Chest Radiographs: Effect on Observers' Performance

    International Nuclear Information System (INIS)

    Lee, Kyung Hee; Goo, Jin Mo; Park, Chang Min; Lee, Hyun Ju; Jin, Kwang Nam

    2012-01-01

    To evaluate the effect of computer-aided detection (CAD) system on observer performance in the detection of malignant lung nodules on chest radiograph. Two hundred chest radiographs (100 normal and 100 abnormal with malignant solitary lung nodules) were evaluated. With CT and histological confirmation serving as a reference, the mean nodule size was 15.4 mm (range, 7-20 mm). Five chest radiologists and five radiology residents independently interpreted both the original radiographs and CAD output images using the sequential testing method. The performances of the observers for the detection of malignant nodules with and without CAD were compared using the jackknife free-response receiver operating characteristic analysis. Fifty-nine nodules were detected by the CAD system with a false positive rate of 1.9 nodules per case. The detection of malignant lung nodules significantly increased from 0.90 to 0.92 for a group of observers, excluding one first-year resident (p = 0.04). When lowering the confidence score was not allowed, the average figure of merit also increased from 0.90 to 0.91 (p = 0.04) for all observers after a CAD review. On average, the sensitivities with and without CAD were 87% and 84%, respectively; the false positive rates per case with and without CAD were 0.19 and 0.17, respectively. The number of additional malignancies detected following true positive CAD marks ranged from zero to seven for the various observers. The CAD system may help improve observer performance in detecting malignant lung nodules on chest radiographs and contribute to a decrease in missed lung cancer.

  17. Automated system for lung nodules classification based on wavelet feature descriptor and support vector machine.

    Science.gov (United States)

    Madero Orozco, Hiram; Vergara Villegas, Osslan Osiris; Cruz Sánchez, Vianey Guadalupe; Ochoa Domínguez, Humberto de Jesús; Nandayapa Alfaro, Manuel de Jesús

    2015-02-12

    Lung cancer is a leading cause of death worldwide; it refers to the uncontrolled growth of abnormal cells in the lung. A computed tomography (CT) scan of the thorax is the most sensitive method for detecting cancerous lung nodules. A lung nodule is a round lesion which can be either non-cancerous or cancerous. In the CT, the lung cancer is observed as round white shadow nodules. The possibility to obtain a manually accurate interpretation from CT scans demands a big effort by the radiologist and might be a fatiguing process. Therefore, the design of a computer-aided diagnosis (CADx) system would be helpful as a second opinion tool. The stages of the proposed CADx are: a supervised extraction of the region of interest to eliminate the shape differences among CT images. The Daubechies db1, db2, and db4 wavelet transforms are computed with one and two levels of decomposition. After that, 19 features are computed from each wavelet sub-band. Then, the sub-band and attribute selection is performed. As a result, 11 features are selected and combined in pairs as inputs to the support vector machine (SVM), which is used to distinguish CT images containing cancerous nodules from those not containing nodules. The clinical data set used for experiments consists of 45 CT scans from ELCAP and LIDC. For the training stage 61 CT images were used (36 with cancerous lung nodules and 25 without lung nodules). The system performance was tested with 45 CT scans (23 CT scans with lung nodules and 22 without nodules), different from that used for training. The results obtained show that the methodology successfully classifies cancerous nodules with a diameter from 2 mm to 30 mm. The total preciseness obtained was 82%; the sensitivity was 90.90%, whereas the specificity was 73.91%. The CADx system presented is competitive with other literature systems in terms of sensitivity. The system reduces the complexity of classification by not performing the typical segmentation stage of most CADx

  18. A mixed reality approach for stereo-tomographic quantification of lung nodules.

    Science.gov (United States)

    Chen, Mianyi; Kalra, Mannudeep K; Yun, Wenbing; Cong, Wenxiang; Yang, Qingsong; Nguyen, Terry; Wei, Biao; Wang, Ge

    2016-05-25

    To reduce the radiation dose and the equipment cost associated with lung CT screening, in this paper we propose a mixed reality based nodule measurement method with an active shutter stereo imaging system. Without involving hundreds of projection views and subsequent image reconstruction, we generated two projections of an iteratively placed ellipsoidal volume in the field of view and merging these synthetic projections with two original CT projections. We then demonstrated the feasibility of measuring the position and size of a nodule by observing whether projections of an ellipsoidal volume and the nodule are overlapped from a human observer's visual perception through the active shutter 3D vision glasses. The average errors of measured nodule parameters are less than 1 mm in the simulated experiment with 8 viewers. Hence, it could measure real nodules accurately in the experiments with physically measured projections.

  19. Central focused convolutional neural networks: Developing a data-driven model for lung nodule segmentation.

    Science.gov (United States)

    Wang, Shuo; Zhou, Mu; Liu, Zaiyi; Liu, Zhenyu; Gu, Dongsheng; Zang, Yali; Dong, Di; Gevaert, Olivier; Tian, Jie

    2017-08-01

    Accurate lung nodule segmentation from computed tomography (CT) images is of great importance for image-driven lung cancer analysis. However, the heterogeneity of lung nodules and the presence of similar visual characteristics between nodules and their surroundings make it difficult for robust nodule segmentation. In this study, we propose a data-driven model, termed the Central Focused Convolutional Neural Networks (CF-CNN), to segment lung nodules from heterogeneous CT images. Our approach combines two key insights: 1) the proposed model captures a diverse set of nodule-sensitive features from both 3-D and 2-D CT images simultaneously; 2) when classifying an image voxel, the effects of its neighbor voxels can vary according to their spatial locations. We describe this phenomenon by proposing a novel central pooling layer retaining much information on voxel patch center, followed by a multi-scale patch learning strategy. Moreover, we design a weighted sampling to facilitate the model training, where training samples are selected according to their degree of segmentation difficulty. The proposed method has been extensively evaluated on the public LIDC dataset including 893 nodules and an independent dataset with 74 nodules from Guangdong General Hospital (GDGH). We showed that CF-CNN achieved superior segmentation performance with average dice scores of 82.15% and 80.02% for the two datasets respectively. Moreover, we compared our results with the inter-radiologists consistency on LIDC dataset, showing a difference in average dice score of only 1.98%. Copyright © 2017. Published by Elsevier B.V.

  20. Surgical Treatment of Small Pulmonary Nodules Under Video-assisted Thoracoscopy 
(A Report of 129 Cases

    Directory of Open Access Journals (Sweden)

    Tong WANG

    2017-01-01

    Full Text Available Background and objective The development of image technology has led to increasing detection of pulmonary small nodules year by year, but the determination of their nature before operation is difficult. This clinical study aimed to investigate the necessity and feasibility of surgical resection of pulmonary small nodules through a minimally invasive approach and the operational manner of non-small cell lung cancer (NSCLC. Methods The clinical data of 129 cases with pulmonary small nodule of 10 mm or less in diameter were retrospectively analyzed in our hospital from December 2013 to November 2016. Thin-section computed tomography (CT was performed on all cases with 129 pulmonary small nodules. CT-guided hook-wire precise localization was performed on 21 cases. Lobectomy, wedge resection, and segmentectomy with lymph node dissection might be performed in patients according to physical condition. Results Results of the pathological examination of 37 solid pulmonary nodules (SPNs revealed 3 primary squamous cell lung cancers, 3 invasive adenocarcinomas (IAs, 2 metastatic cancers, 2 small cell lung cancers (SCLCs, 16 hamartomas, and 12 nonspecific chronic inflammations. The results of pathological examination of 49 mixed ground glass opacities revealed 19 IAs, 6 micro invasive adenocarcinomas (MIAs, 4 adenocarcinomas in situ (AIS, 1 atypical adenomatous hyperplasia (AAH, 1 SCLC, and 18 nonspecific chronic inflammations. The results of pathological examination of 43 pure ground glass opacities revealed 19 AIS, 6 MIAs, 6 IA, 6 AAHs, and 6 nonspecific chronic inflammations. Wedge resection under video-assisted thoracoscopic surgery (VATS was performed in patients with 52 benign pulmonary small nodules. Lobectomy and systematic lymph node dissection under VATS were performed in 33 patients with NSCLC. Segmentectomy with selective lymph node dissection, wedge resection, and selective lymph node dissection under VATS were performed in six patients with

  1. Preliminary evaluation of lung care software of 16-slice helical CT in the study of pulmonary nodules

    International Nuclear Information System (INIS)

    Song Wei; Jin Zhengyu; Yan Hongzhen; Wang Yun; Zhang Yunqing; Wang Linhui; Zhu Haifeng; Liang Jixiang; Qi Bing

    2005-01-01

    Objective: To evaluate the auxiliary diagnostic ability and applicability of the Lung Care software for the study of the pulmonary nodules. Methods: Fifty-six patients underwent low-dose CT scan with 1.5 mm collimation, 4 mm reconstruction interval, and 4 mm reconstruction slice in group A, and with 1.5 mm collimation, 2 mm reconstruction interval, and 2 mm reconstruction slice in group B. 12 patients underwent low-dose CT with 0.75 mm collimation, 0.75 mm reconstruction interval, and 0.75 mm reconstruction slice in group C. The nodules detected in groups A, B, and C were analyzed by r-MPR or VOI of the Lung Care software to distinguish the true pulmonary nodules from the vessels. The volume and density distribution of the true pulmonary nodules in groups A, B, and C were measured with the Lung Care software. Results: It was difficult to observe the diffuse pulmonary nodules by r-MPR or VOI of the Lung Care software. The images of each patient in group C were too many to be applied in the clinic. There was statistically consistent in the observation of pulmonary nodules between r-MPR and VOI, but the coincidence was not good (Kappa=0.369, P=0.002). There was statistically significant difference in showing faint nodules between r-MPR and VOI (P=0.001), r-MPR was better than VOI. There was statistically significant difference between group A and B in showing = 3.886, P=0.045), but no statistically significant difference in showing 5-10 mm nodules (χ 2 =0.170, P=0.680). The volume and density distribution of most 5 - ≤20 mm nodules were successfully measured with the Lung Care software, whereas those of most 2 =5.811, P=0.016) and 5-10 mm nodules (χ 2 =13.500, P 10 - ≤20 mm nodules (χ 2 =0.000, P=1.000). Conclusion: For distinguishing the true pulmonary nodules from others, the Lung Care software is suitable for the well-edged pulmonary nodules and most faint nodules, but not suitable for the nodules such as ground-glass opacity. For measuring the volume and

  2. SU-F-R-22: Malignancy Classification for Small Pulmonary Nodules with Radiomics and Logistic Regression

    Energy Technology Data Exchange (ETDEWEB)

    Huang, W; Tu, S [Chang Gung University, Kwei-shan, Tao-Yuan, Taiwan (China)

    2016-06-15

    Purpose: We conducted a retrospective study of Radiomics research for classifying malignancy of small pulmonary nodules. A machine learning algorithm of logistic regression and open research platform of Radiomics, IBEX (Imaging Biomarker Explorer), were used to evaluate the classification accuracy. Methods: The training set included 100 CT image series from cancer patients with small pulmonary nodules where the average diameter is 1.10 cm. These patients registered at Chang Gung Memorial Hospital and received a CT-guided operation of lung cancer lobectomy. The specimens were classified by experienced pathologists with a B (benign) or M (malignant). CT images with slice thickness of 0.625 mm were acquired from a GE BrightSpeed 16 scanner. The study was formally approved by our institutional internal review board. Nodules were delineated and 374 feature parameters were extracted from IBEX. We first used the t-test and p-value criteria to study which feature can differentiate between group B and M. Then we implemented a logistic regression algorithm to perform nodule malignancy classification. 10-fold cross-validation and the receiver operating characteristic curve (ROC) were used to evaluate the classification accuracy. Finally hierarchical clustering analysis, Spearman rank correlation coefficient, and clustering heat map were used to further study correlation characteristics among different features. Results: 238 features were found differentiable between group B and M based on whether their statistical p-values were less than 0.05. A forward search algorithm was used to select an optimal combination of features for the best classification and 9 features were identified. Our study found the best accuracy of classifying malignancy was 0.79±0.01 with the 10-fold cross-validation. The area under the ROC curve was 0.81±0.02. Conclusion: Benign nodules may be treated as a malignant tumor in low-dose CT and patients may undergo unnecessary surgeries or treatments. Our

  3. Surveillance of the remaining nodules after resection of the dominant lung adenocarcinoma is an appropriate follow-up strategy

    Directory of Open Access Journals (Sweden)

    Massimo eCastiglioni

    2015-01-01

    Full Text Available IntroductionAdenocarcinomas, commonly present as a dominant lesion (DL with additional nodules in the ipsilateral or contralateral lung. We sought to determine the fate and management of the secondary nodules and to assess the risk of these nodules using the Lung CT Screening Reporting and Data System (Lung-RADS criteria and the National Comprehensive Cancer Network (NCCN guidelines to determine if surveillance is an appropriate strategy.MethodsWe retrospectively evaluated patients with lepidic growth pattern adenocarcinoma and secondary nodules from 2000 to 2013. Risk assessment of the additional lesions was completed with a simplified model of Lung-RADS and NCCN-Guidelines. ResultsEighty-seven patients underwent resection of 87 DLs (Group 1 concurrently with 60 additional pulmonary nodules (Group 2 while 157 non-DLs were radiologically surveyed over a median follow-up time of 3.2 years (Group 3. Malignancy was found in 29/60 (48% nodules in Group 2. Whereas, only 9/157 (6% of the lesions in Group 3 enlarged, 4 of which (2.5% of total were found to be malignant, and then treated, while the remaining nodules continued surveillance. After applying the Lung-RADS and NCCN simplified models, nodules in Group 2 were at higher risk for lung cancer than those in Group 3. ConclusionsIn patients with lepidic growth pattern adenocarcinoma associated with multiple secondary nodules, surveillance of the remaining nodules, after resection of the DL, is a reasonable strategy since these nodules exhibited a slow rate of growth and minimal malignancy. In contrast, nodules resected from the ipsilateral lung at the time of the DL, harbor malignancy in 48%. Risk assessment models may provide a useful and standardized tool for clinical assessment of pulmonary nodules.

  4. The MAGIC-5 CAD for nodule detection in low dose and thin slice lung CTs

    International Nuclear Information System (INIS)

    Cerello, Piergiorgio

    2010-01-01

    Lung cancer is the leading cause of cancer-related mortality in developed countries. Only 10-15% of all men and women diagnosed with lung cancer live 5 years after the diagnosis. However, the 5-year survival rate for patients diagnosed in the early asymptomatic stage of the disease can reach 70%. Early-stage lung cancers can be diagnosed by detecting non-calcified small pulmonary nodules with computed tomography (CT). Computer-aided detection (CAD) could support radiologists in the analysis of the large amount of noisy images generated in screening programs, where low-dose and thin-slice settings are used. The MAGIC-5 project, funded by the Istituto Nazionale di Fisica Nucleare (INFN, Italy) and Ministero dell'Universita e della Ricerca (MUR, Italy), developed a multi-method approach based on three CAD algorithms to be used in parallel with a merging of their results: the Channeler Ant Model (CAM), based on Virtual Ant Colonies, the Dot-Enhancement/Pleura Surface Normals/VBNA (DE-PSN-VBNA), and the Region Growing Volume Plateau (RGVP). Preliminary results show quite good performances, to be improved with the refining of the single algorithm and the added value of the results merging.

  5. Radiomic features analysis in computed tomography images of lung nodule classification.

    Directory of Open Access Journals (Sweden)

    Chia-Hung Chen

    Full Text Available Radiomics, which extract large amount of quantification image features from diagnostic medical images had been widely used for prognostication, treatment response prediction and cancer detection. The treatment options for lung nodules depend on their diagnosis, benign or malignant. Conventionally, lung nodule diagnosis is based on invasive biopsy. Recently, radiomics features, a non-invasive method based on clinical images, have shown high potential in lesion classification, treatment outcome prediction.Lung nodule classification using radiomics based on Computed Tomography (CT image data was investigated and a 4-feature signature was introduced for lung nodule classification. Retrospectively, 72 patients with 75 pulmonary nodules were collected. Radiomics feature extraction was performed on non-enhanced CT images with contours which were delineated by an experienced radiation oncologist.Among the 750 image features in each case, 76 features were found to have significant differences between benign and malignant lesions. A radiomics signature was composed of the best 4 features which included Laws_LSL_min, Laws_SLL_energy, Laws_SSL_skewness and Laws_EEL_uniformity. The accuracy using the signature in benign or malignant classification was 84% with the sensitivity of 92.85% and the specificity of 72.73%.The classification signature based on radiomics features demonstrated very good accuracy and high potential in clinical application.

  6. Aquamous cell carcinomas of the lung which presented as numerous polypoid nodules in the tracheobronchial tree: A case report

    Energy Technology Data Exchange (ETDEWEB)

    Lee, Hyun Gyu; Choi, Yo Won; Yoon, Hyun Jung; Paik, Seung Sam [Hanyang University Hospital, Hanyang University College of Medicine, Seoul (Korea, Republic of)

    2017-03-15

    We report a case of squamous cell carcinomas of the lung, which presented as numerous polypoid nodules in the tracheobronchial tree. They occurred at two years and 7 months after resection of squamous cell carcinoma, which presented as a lung nodule in the left lower lobe, and at 7 months after resection of tracheal squamous cell carcinoma.

  7. Aquamous cell carcinomas of the lung which presented as numerous polypoid nodules in the tracheobronchial tree: A case report

    International Nuclear Information System (INIS)

    Lee, Hyun Gyu; Choi, Yo Won; Yoon, Hyun Jung; Paik, Seung Sam

    2017-01-01

    We report a case of squamous cell carcinomas of the lung, which presented as numerous polypoid nodules in the tracheobronchial tree. They occurred at two years and 7 months after resection of squamous cell carcinoma, which presented as a lung nodule in the left lower lobe, and at 7 months after resection of tracheal squamous cell carcinoma

  8. An Unusual Radiologic Manifestation of Pulmonary Tuberculosis with Bilateral Multiple Lung Nodules and Diffuse Alveolar Hemorrhage: A Case Report

    Energy Technology Data Exchange (ETDEWEB)

    Jeong, Seo In; Seon, Hyun Ju; Kim, Yun Hyeon [Dept. of Radiology, Chunnam National University Hospital, Gwangju (Korea, Republic of); Choi, Sung [Dept. of Radiology, Chunnam National University Hwasun Hospital, Hwasun(Korea, Republic of)

    2011-12-15

    Pulmonary tuberculosis presenting as bilateral multiple lung nodules or diffuse alveolar hemorrhage is very rare. Here, we report a case of pulmonary tuberculosis presenting as bilateral multiple lung nodules and diffuse alveolar hemorrhage mimicking granulomatous vasculitis, such as Wegener's granulomatosis.

  9. Cryptogenic Organizing Pneumonia With Lung Nodules Secondary to Pulmonary Manifestation of Crohn Disease

    Directory of Open Access Journals (Sweden)

    Taufiq Zaman

    2017-05-01

    Full Text Available Crohn disease is an immune-mediated inflammatory condition with gastrointestinal and extraintestinal manifestations in patients. Pulmonary involvement of Crohn disease is one manifestation. There have been case reports which have shown Crohn disease and lung nodules which were noted to be histopathological as cryptogenic organizing pneumonia (COP. In our case, a 22-year-old woman with Crohn disease was seen with complaints of chest pain and cough. Computed tomographic scan of chest showed multiple bilateral lung nodules, for which biopsy was done, which showed COP. The case study is followed by a deeper discussion of COP and the extraintestinal manifestation seen in inflammatory bowel disease.

  10. Lung Nodule Image Classification Based on Local Difference Pattern and Combined Classifier.

    Science.gov (United States)

    Mao, Keming; Deng, Zhuofu

    2016-01-01

    This paper proposes a novel lung nodule classification method for low-dose CT images. The method includes two stages. First, Local Difference Pattern (LDP) is proposed to encode the feature representation, which is extracted by comparing intensity difference along circular regions centered at the lung nodule. Then, the single-center classifier is trained based on LDP. Due to the diversity of feature distribution for different class, the training images are further clustered into multiple cores and the multicenter classifier is constructed. The two classifiers are combined to make the final decision. Experimental results on public dataset show the superior performance of LDP and the combined classifier.

  11. Lung Nodule Image Classification Based on Local Difference Pattern and Combined Classifier

    Directory of Open Access Journals (Sweden)

    Keming Mao

    2016-01-01

    Full Text Available This paper proposes a novel lung nodule classification method for low-dose CT images. The method includes two stages. First, Local Difference Pattern (LDP is proposed to encode the feature representation, which is extracted by comparing intensity difference along circular regions centered at the lung nodule. Then, the single-center classifier is trained based on LDP. Due to the diversity of feature distribution for different class, the training images are further clustered into multiple cores and the multicenter classifier is constructed. The two classifiers are combined to make the final decision. Experimental results on public dataset show the superior performance of LDP and the combined classifier.

  12. Lung nodule detection on chest CT: evaluation of a computer-aided detection (CAD) system

    International Nuclear Information System (INIS)

    Lee, In Jae; Gamsu, Gordon; Czum, Julianna; Johnson, Rebecca; Chakrapani, Sanjay; Wu, Ning

    2005-01-01

    To evaluate the capacity of a computer-aided detection (CAD) system to detect lung nodules in clinical chest CT. A total of 210 consecutive clinical chest CT scans and their reports were reviewed by two chest radiologists and 70 were selected (33 without nodules and 37 with 1-6 nodules, 4-15.4 mm in diameter). The CAD system (ImageChecker CT LN-1000) developed by R2 Technology, Inc. (Sunnyvale, CA) was used. Its algorithm was designed to detect nodules with a diameter of 4-20 mm. The two chest radiologists working with the CAD system detected a total of 78 nodules. These 78 nodules form the database for this study. Four independent observers interpreted the studies with and without the CAD system. The detection rates of the four independent observers without CAD were 81% (63/78), 85% (66/78), 83% (65/78), and 83% (65/78), respectively. With CAD their rates were 87% (68/78), 85% (66/78), 86% (67/78), and 85% (66/78), respectively. The differences between these two sets of detection rates did not reach statistical significance. In addition, CAD detected eight nodules that were not mentioned in the original clinical radiology reports. The CAD system produced 1.56 false-positive nodules per CT study. The four test observers had 0, 0.1, 0.17, and 0.26 false-positive results per study without CAD and 0.07, 0.2, 0.23, and 0.39 with CAD, respectively. The CAD system can assist radiologists in detecting pulmonary nodules in chest CT, but with a potential increase in their false positive rates. Technological improvements to the system could increase the sensitivity and specificity for the detection of pulmonary nodules and reduce these false-positive results

  13. Pulmonary nodules and masses in lung transplant recipients: clinical and CT findings

    Energy Technology Data Exchange (ETDEWEB)

    Morla, Olivier; Liberge, Renan; Arrigoni, Pierre Paul; Frampas, Eric [Service de Radiologie Centrale, C.H.U. Hotel Dieu, Nantes (France)

    2014-09-15

    The purpose of this study was to review the clinical and CT findings of pulmonary nodules and masses in lung transplant recipients and to determine distinguishing features among the various aetiologies. This retrospective study included 106 lung transplant recipients who had a chest CT performed over a 7-year period in a single institution. Twenty-four cases of pulmonary nodules and masses were observed on CT. Among the single lesions, three (50 %) were due to infections, one (17 %) to organizing pneumonia, and two (33 %) remained of undetermined origin. Among the multiple lesions, 14 (78 %) were due to infection, three to post-transplant lymphoproliferative disorder (17 %), and one to bronchogenic carcinoma (5 %). The two main microorganisms were P. aeruginosa and Aspergillus spp. Among 12 solid nodules > 1 cm, four (33 %) were due to malignancy: three post-transplant lymphoproliferative disorders (25 %), and one bronchogenic carcinoma (8 %). Among five cavitary nodules four (80 %) were due to aspergillosis. Infection is the most frequent aetiology of pulmonary nodules and masses in lung transplant recipients, but other causes such as post-transplant lymphoproliferative disorder, bronchogenic carcinoma, or organizing pneumonia should be considered. (orig.)

  14. Usefulness of virtual images of the visceral pleura in identifying the localization of peripheral small pulmonary nodules intraoperatively

    International Nuclear Information System (INIS)

    Kambayashi, Takatoyo

    2011-01-01

    The objective of this study was to assess the usefulness of virtual images of the visceral pleura in identifying the localization of peripheral small pulmonary nodules intraoperatively. We examined 12 cases with 12 peripheral small pulmonary nodules between 2008 and 2010. All lesions were predicted to be difficult to identify during surgery, and virtual images of the visceral pleura were made and evaluated before surgery. We predicted the usefulness of virtual images of the visceral pleura in identifying the localization of peripheral small pulmonary nodules. The mean maximum dimensions were 10.5±4.36 mm. The mean depth from the visceral pleura was 4.0±4.67 mm. The lesions were the solid type in 6 cases and the ground-glass opacity type in 6 cases. In 7 cases primary lung cancer was present, while the other 5 cases had only benign lesions. In all cases, changes in the visceral pleura could be identified with virtual images of the visceral pleura before surgery. We identified 7 lesions out of 12 intraoperatively. The reasons for the failure to identify the lesions were an inability to adequately observe the visceral pleura because of pleural adhesion, or failure to perform single lung ventilation in 3 cases. Another reason was that the changes in the visceral pleura were too minor to identify intraoperatively (2 cases). Virtual images of the visceral pleura may be useful for identifying the localization of peripheral small pulmonary nodules, and the prediction of whether or not the identification of lesions is possible intraoperatively, without preoperative marking in order to identify peripheral pulmonary nodules. (author)

  15. A Computer-Aided Diagnosis for Evaluating Lung Nodules on Chest CT: the Current Status and Perspective

    Energy Technology Data Exchange (ETDEWEB)

    Goo, Jin Mo [Seoul National University Medical Research Center, Seoul (Korea, Republic of)

    2011-04-15

    As the detection and characterization of lung nodules are of paramount importance in thoracic radiology, various tools for making a computer-aided diagnosis (CAD) have been developed to improve the diagnostic performance of radiologists in clinical practice. Numerous studies over the years have shown that the CAD system can effectively help readers identify more nodules. Moreover, nodule malignancy and the response of malignant lung tumors to treatment can also be assessed using nodule volumetry. CAD also has the potential to objectively analyze the morphology of nodules and enhance the work flow during the assessment of follow-up studies. Therefore, understanding the current status and limitations of CAD for evaluating lung nodules is essential to effectively apply CAD in clinical practice

  16. Malignancy estimation of Lung-RADS criteria for subsolid nodules on CT. Accuracy of low and high risk spectrum when using NLST nodules

    Energy Technology Data Exchange (ETDEWEB)

    Chung, Kaman; Jacobs, Colin; Scholten, Ernst T.; Dekker, Irma; Prokop, Mathias; Ginneken, Bram van [Radboud University Medical Centre, Diagnostic Image Analysis Group, Department of Radiology and Nuclear Medicine, Nijmegen (Netherlands); Mets, Onno M. [University Medical Center Utrecht, Department of Radiology, Utrecht (Netherlands); Schaefer-Prokop, Cornelia M. [Radboud University Medical Centre, Diagnostic Image Analysis Group, Department of Radiology and Nuclear Medicine, Nijmegen (Netherlands); Meander Medical Center, Department of Radiology, Amersfoort (Netherlands)

    2017-11-15

    Lung-RADS proposes malignancy probabilities for categories 2 (<1%) and 4B (>15%). The purpose of this study was to quantify and compare malignancy rates for Lung-RADS 2 and 4B subsolid nodules (SSNs) on a nodule base. We identified all baseline SSNs eligible for Lung-RADS 2 and 4B in the National Lung Screening Trial (NLST) database. Solid cores and nodule locations were annotated using in-house software. Malignant SSNs were identified by an experienced radiologist using NLST information. Malignancy rates and percentages of persistence were calculated. Of the Lung-RADS 2SSNs, 94.3% (1790/1897) could be located on chest CTs. Likewise, 95.1% (331/348) of part-solid nodules ≥6 mm in diameter could be located. Of these, 120 had a solid core ≥8 mm, corresponding to category 4B. Category 2 SSNs showed a malignancy rate of 2.5%, exceeding slightly the proposed rate of <1%. Category 4B SSNs showed a malignancy rate of 23.9%. In both categories one third of benign lesions were transient. Malignancy probabilities for Lung-RADS 2 and 4B generally match malignancy rates in SSNs. An option to include also category 2 SSNs for upgrade to 4X designed for suspicious nodules might be useful in the future. Integration of short-term follow-up to confirm persistence would prevent unnecessary invasive work-up in 4B SSNs. (orig.)

  17. Outcomes of Stereotactic Body Radiotherapy (SBRT) treatment of multiple synchronous and recurrent lung nodules

    International Nuclear Information System (INIS)

    Owen, Dawn; Olivier, Kenneth R; Mayo, Charles S; Miller, Robert C; Nelson, Kathryn; Bauer, Heather; Brown, Paul D; Park, Sean S; Ma, Daniel J; Garces, Yolanda I

    2015-01-01

    Stereotactic body radiotherapy (SBRT) is evolving into a standard of care for unresectable lung nodules. Local control has been shown to be in excess of 90% at 3 years. However, some patients present with synchronous lung nodules in the ipsilateral or contralateral lobe or metasynchronous disease. In these cases, patients may receive multiple courses of lung SBRT or a single course for synchronous nodules. The toxicity of such treatment is currently unknown. Between 2006 and 2012, 63 subjects with 128 metasynchronous and synchronous lung nodules were treated at the Mayo Clinic with SBRT. Demographic patient data and dosimetric data regarding SBRT treatments were collected. Acute toxicity (defined as toxicity < 90 days) and late toxicity (defined as toxicity > = 90 days) were reported and graded as per standardized CTCAE 4.0 criteria. Local control, progression free survival and overall survival were also described. The median age of patients treated was 73 years. Sixty five percent were primary or recurrent lung cancers with the remainder metastatic lung nodules of varying histologies. Of 63 patients, 18 had prior high dose external beam radiation to the mediastinum or chest. Dose and fractionation varied but the most common prescriptions were 48 Gy/4 fractions, 54 Gy/3 fractions, and 50 Gy/5 fractions. Only 6 patients demonstrated local recurrence. With a median follow up of 12.6 months, median SBRT specific overall survival and progression free survival were 35.7 months and 10.7 months respectively. Fifty one percent (32/63 patients) experienced acute toxicity, predominantly grade 1 and 2 fatigue. One patient developed acute grade 3 radiation pneumonitis at 75 days. Forty six percent (29/63 patients) developed late effects. Most were grade 1 dyspnea. There was one patient with grade 5 pneumonitis. Multiple courses of SBRT and SBRT delivery after external beam radiotherapy appear to be feasible and safe. Most toxicity was grade 1 and 2 but the risk was

  18. Towards automatic pulmonary nodule management in lung cancer screening with deep learning

    NARCIS (Netherlands)

    Ciompi, F.; Chung, K; Riel, S.J. van; Setio, A.A.A.; Gerke, P.K.; Jacobs, C.; Scholten, E.T.; Schaefer-Prokop, C.M.; Wille, M.M.W.; Marchiano, A.; Pastorino, U.; Prokop, M.; Ginneken, B. van

    2017-01-01

    The introduction of lung cancer screening programs will produce an unprecedented amount of chest CT scans in the near future, which radiologists will have to read in order to decide on a patient follow-up strategy. According to the current guidelines, the workup of screen-detected nodules strongly

  19. Incidental perifissural nodules on routine chest computed tomography. Lung cancer or not?

    Energy Technology Data Exchange (ETDEWEB)

    Mets, Onno M.; Veldhuis, Wouter B.; Jong, Pim A. de [University Medical Center Utrecht, Department of Radiology, Utrecht (Netherlands); Chung, Kaman; Scholten, Ernst T.; Ginneken, Bram van [Radboud University Nijmegen Medical Centre, Diagnostic Image Analysis Group, Nijmegen (Netherlands); Prokop, M. [Radboud University Nijmegen Medical Centre, Department of Radiology, Nijmegen (Netherlands); Schaefer-Prokop, Cornelia M. [Radboud University Nijmegen Medical Centre, Diagnostic Image Analysis Group, Nijmegen (Netherlands); Meander Medical Center, Department of Radiology, Amersfoort (Netherlands)

    2018-03-15

    Perifissural nodules (PFNs) are a common finding on chest CT, and are thought to represent non-malignant lesions. However, data outside a lung cancer-screening setting are currently lacking. In a nested case-control design, out of a total cohort of 16,850 patients ≥ 40 years of age who underwent routine chest CT (2004-2012), 186 eligible subjects with incident lung cancer and 511 controls without were investigated. All non-calcified nodules ≥ 4 mm were semi-automatically annotated. Lung cancer location and subject characteristics were recorded. Cases (56 % male) had a median age of 64 years (IQR 59-70). Controls (60 % male) were slightly younger (p<0.01), median age of 61 years (IQR 51-70). A total of 262/1,278 (21 %) unique non-calcified nodules represented a PFN. None of these were traced to a lung malignancy over a median follow-up of around 4.5 years. PFNs were most often located in the lower lung zones (72 %, p<0.001). Median diameter was 4.6 mm (range: 4.0-8.1), volume 51 mm{sup 3} (range: 32-278). Some showed growth rates < 400 days. Our data show that incidental PFNs do not represent lung cancer in a routine care, heterogeneous population. This confirms prior screening-based results. (orig.)

  20. Application of a kernel-based online learning algorithm to the classification of nodule candidates in computer-aided detection of CT lung nodules

    International Nuclear Information System (INIS)

    Matsumoto, S.; Ohno, Y.; Takenaka, D.; Sugimura, K.; Yamagata, H.

    2007-01-01

    Classification of the nodule candidates in computer-aided detection (CAD) of lung nodules in CT images was addressed by constructing a nonlinear discriminant function using a kernel-based learning algorithm called the kernel recursive least-squares (KRLS) algorithm. Using the nodule candidates derived from the processing by a CAD scheme of 100 CT datasets containing 253 non-calcified nodules or 3 mm or larger as determined by the consensus of two thoracic radiologists, the following trial were carried out 100 times: by randomly selecting 50 datasets for training, a nonlinear discriminant function was obtained using the nodule candidates in the training datasets and tested with the remaining candidates; for comparison, a rule-based classification was tested in a similar manner. At the number of false positives per case of about 5, the nonlinear classification method showed an improved sensitivity of 80% (mean over the 100 trials) compared with 74% of the rule-based method. (orig.)

  1. Application of CT-PSF-based computer-simulated lung nodules for evaluating the accuracy of computer-aided volumetry.

    Science.gov (United States)

    Funaki, Ayumu; Ohkubo, Masaki; Wada, Shinichi; Murao, Kohei; Matsumoto, Toru; Niizuma, Shinji

    2012-07-01

    With the wide dissemination of computed tomography (CT) screening for lung cancer, measuring the nodule volume accurately with computer-aided volumetry software is increasingly important. Many studies for determining the accuracy of volumetry software have been performed using a phantom with artificial nodules. These phantom studies are limited, however, in their ability to reproduce the nodules both accurately and in the variety of sizes and densities required. Therefore, we propose a new approach of using computer-simulated nodules based on the point spread function measured in a CT system. The validity of the proposed method was confirmed by the excellent agreement obtained between computer-simulated nodules and phantom nodules regarding the volume measurements. A practical clinical evaluation of the accuracy of volumetry software was achieved by adding simulated nodules onto clinical lung images, including noise and artifacts. The tested volumetry software was revealed to be accurate within an error of 20 % for nodules >5 mm and with the difference between nodule density and background (lung) (CT value) being 400-600 HU. Such a detailed analysis can provide clinically useful information on the use of volumetry software in CT screening for lung cancer. We concluded that the proposed method is effective for evaluating the performance of computer-aided volumetry software.

  2. Differential diagnosis and cancer staging of a unique case with multiple nodules in the lung - lung adenocarcinoma, metastasis of colon adenocarcinoma, and colon adenocarcinoma metastasizing to lung adenocarcinoma.

    Science.gov (United States)

    Bai, Yun; Qiu, Jianxing; Shang, Xueqian; Liu, Ping; Zhang, Ying; Wang, Ying; Xiong, Yan; Li, Ting

    2015-05-01

    Lung cancer is the most common cancer in the world. Despite this, there have been few cases of simultaneous primary and metastatic cancers in the lung reported, let alone coexisting with tumor-to-tumor metastasis. Herein, we describe an extremely unusual case. A 61-year-old man with a history of colon adenocarcinoma was revealed as having three nodules in the lung 11 months after colectomy. The nodule in the left upper lobe was primary lung adenocarcinoma, the larger one in the right upper lobe was a metastasis of colon adenocarcinoma, and the smaller one in the right upper lobe was colon adenocarcinoma metastasizing to lung adenocarcinoma. Our paper focused on the differential diagnosis and cancer staging of this unique case, and discussed the uncommon phenomenon of the lung acting as a recipient in tumor-to-tumor metastasis.

  3. Pleural Dye Marking Using Radial Endobronchial Ultrasound and Virtual Bronchoscopy before Sublobar Pulmonary Resection for Small Peripheral Nodules.

    Science.gov (United States)

    Lachkar, Samy; Baste, Jean-Marc; Thiberville, Luc; Peillon, Christophe; Rinieri, Philippe; Piton, Nicolas; Guisier, Florian; Salaun, Mathieu

    2018-01-01

    Minimally invasive surgery of pulmonary nodules allows suboptimal palpation of the lung compared to open thoracotomy. The objective of this study was to assess endoscopic pleural dye marking using radial endobronchial ultrasound (r-EBUS) and virtual bronchoscopy to localize small peripheral lung nodules immediately before minimally invasive resection. The endoscopic procedure was performed without fluoroscopy, under general anesthesia in the operating room immediately before minimally invasive surgery. Then, 1 mL of methylene blue (0.5%) was instilled into the guide sheath, wedged in the subpleural space. Wedge resection or segmentectomy were guided by visualization of the dye on the pleural surface. Contribution of dye marking to the surgical procedure was rated by the surgeon. Twenty-five nodules, including 6 ground glass opacities, were resected in 22 patients by video-assisted thoracoscopic wedge resection (n = 11) or robotic-assisted thoracoscopic surgery (10 segmentectomies and 1 wedge resection). The median greatest diameter of nodules was 8 mm. No conversion to open thoracotomy was needed. The endoscopic procedure added an average 10 min to surgical resection. The dye was visible on the pleural surface in 24 cases. Histological diagnosis and free margin resection were obtained in all cases. Median skin-to-skin operating time was 90 min for robotic segmentectomy and 40 min for video-assisted wedge resection. The same operative precision was considered impossible by the surgeon without dye marking in 21 cases. Dye marking using r-EBUS and virtual bronchoscopy can be easily and safely performed to localize small pulmonary nodules immediately before minimally invasive resection. © 2018 S. Karger AG, Basel.

  4. The computer tomography application of LUNG CARE to detect pulmonary nodules

    International Nuclear Information System (INIS)

    Minnoso Arabi, Yaysel; Ugarte Moreno, Dayana; Jordan Gonzalez, Jose

    2011-01-01

    The pulmonary nodule multiple or unique is frequently a casual finding and it is one of lung's cancer presentation. It's known that cancer is one of the first causes of death in our country and pulmonary tumor has become in a major sanitary problem. Methods. A descriptive prospective was carried out to detect pulmonary nodules in Medical Surgical Research Center. Patients were seen in General Medicine Consultation, in the period of time between January and December 2009. An inquiry was applied to every patients and a computer tomography scan with LUNG CARE program was performed to them. LUNG CARE program is used to early diagnosis and study of pulmonary nodule (mass). The data were analyzed with statistic packet SPSS version 13.0, for Windows. The data were summarized by means of stockings, deviations standard and percent, according to the variable type. For the comparison of the detection of nodules according to technical imagenology the test Chi -square was used at a level of significance of 0,05

  5. Lung nodule detection by microdose CT versus chest radiography (standard and dual-energy subtracted).

    Science.gov (United States)

    Ebner, Lukas; Bütikofer, Yanik; Ott, Daniel; Huber, Adrian; Landau, Julia; Roos, Justus E; Heverhagen, Johannes T; Christe, Andreas

    2015-04-01

    The purpose of this study was to investigate the feasibility of microdose CT using a comparable dose as for conventional chest radiographs in two planes including dual-energy subtraction for lung nodule assessment. We investigated 65 chest phantoms with 141 lung nodules, using an anthropomorphic chest phantom with artificial lung nodules. Microdose CT parameters were 80 kV and 6 mAs, with pitch of 2.2. Iterative reconstruction algorithms and an integrated circuit detector system (Stellar, Siemens Healthcare) were applied for maximum dose reduction. Maximum intensity projections (MIPs) were reconstructed. Chest radiographs were acquired in two projections with bone suppression. Four blinded radiologists interpreted the images in random order. A soft-tissue CT kernel (I30f) delivered better sensitivities in a pilot study than a hard kernel (I70f), with respective mean (SD) sensitivities of 91.1%±2.2% versus 85.6%±5.6% (p=0.041). Nodule size was measured accurately for all kernels. Mean clustered nodule sensitivity with chest radiography was 45.7%±8.1% (with bone suppression, 46.1%±8%; p=0.94); for microdose CT, nodule sensitivity was 83.6%±9% without MIP (with additional MIP, 92.5%±6%; pmicrodose CT for readers 1, 2, 3, and 4 were 84.3%, 90.7%, 68.6%, and 45.0%, respectively. Sensitivities with chest radiography for readers 1, 2, 3, and 4 were 42.9%, 58.6%, 36.4%, and 90.7%, respectively. In the per-phantom analysis, respective sensitivities of microdose CT versus chest radiography were 96.2% and 75% (pmicrodose CT, the applied dose was 0.1323 mSv. Microdose CT is better than the combination of chest radiography and dual-energy subtraction for the detection of solid nodules between 5 and 12 mm at a lower dose level of 0.13 mSv. Soft-tissue kernels allow better sensitivities. These preliminary results indicate that microdose CT has the potential to replace conventional chest radiography for lung nodule detection.

  6. Use of morphologic filters in the computerized detection of lung nodules in digital chest images

    International Nuclear Information System (INIS)

    Yoshimura, H.; Giger, M.L.; Doi, K.; Ahn, N.; MacMahon, H.

    1989-01-01

    The authors have previously described a computerized scheme for the detection of lung nodules based on a difference-image approach, which had a detection accuracy of 70% with 7--8 false positives per image. Currently, they are investigating morphologic filters for the further enhancement/suppression of nodule-signals and the removal of false-positives. Gray-level morphologic filtering is performed on clinical chest radiographs digitized with an optical drum scanner. Various shapes and sequences of erosion and dilation filters (i.e., determination of the minimum and maximum gray levels, respectively) were examined for signal enhancement and suppression for sue in the difference- image approach

  7. Prognostic importance of pleural attachment status measured by pretreatment CT images in patients with stage IA lung adenocarcinoma: measurement of the ratio of the interface between nodule and neighboring pleura to nodule surface area

    Science.gov (United States)

    Kawata, Y.; Niki, N.; Kusumoto, M.; Ohmatsu, H.; Aokage, K.; Ishii, G.; Matsumoto, Y.; Tsuchida, T.; Eguchi, K.; Kaneko, M.

    2018-02-01

    Screening for lung cancer with low-dose computed tomography (CT) has led to increased recognition of small lung cancers and is expected to increase the rate of detection of early-stage lung cancer. Major concerns in the implementation of the CT screening of large populations include determining the appropriate management of pulmonary nodules found on a scan. The identification of patients with early-stage lung cancer who have a higher risk for relapse and who require more aggressive surveillance has been a target of intense investigation. This study was performed to investigate whether image features of internal intensity in combination with surrounding structure characteristics are associated with an increased risk of relapse in patients with stage IA lung adenocarcinoma. We focused on pleural attachment status which is one of morphological characteristics associated with prognosis in three-dimensional thoracic CT images.

  8. Systematic Error in Lung Nodule Volumetry : Effect of Iterative Reconstruction Versus Filtered Back Projection at Different CT Parameters

    NARCIS (Netherlands)

    Willemink, Martin J.; Leiner, Tim; Budde, Ricardo P. J.; de Kort, Freek P. L.; Vliegenthart, Rozemarijn; van Ooijen, Peter M. A.; Oudkerk, Matthijs; de Jong, Pim A.

    2012-01-01

    OBJECTIVE. Iterative reconstruction potentially can reduce radiation dose compared with filtered back projection (FBP) for chest CT. This is especially important for repeated CT scanning, as is the case in patients with indeterminate lung nodules. It is currently unknown whether absolute nodule

  9. AUTOMATIC LUNG NODULE SEGMENTATION USING AUTOSEED REGION GROWING WITH MORPHOLOGICAL MASKING (ARGMM AND FEATURE EX-TRACTION THROUGH COMPLETE LOCAL BINARY PATTERN AND MICROSCOPIC INFORMATION PATTERN

    Directory of Open Access Journals (Sweden)

    Senthil Kumar

    2015-04-01

    Full Text Available An efficient Autoseed Region Growing with Morphological Masking(ARGMM is imple-mented in this paper on the Lung CT Slice to segment the 'Lung Nodules',which may be the potential indicator for the Lung Cancer. The segmentation of lung nodules car-ried out in this paper through Multi-Thresholding, ARGMM and Level Set Evolution. ARGMM takes twice the time compared to Level Set, but still the number of suspected segmented nodules are doubled, which make sure that no potential cancerous nodules go unnoticed at the earlier stages of diagnosis. It is very important not to panic the patient by finding the presence of nodules from Lung CT scan. Only 40 percent of nod-ules can be cancerous. Hence, in this paper an efficient Shape and Texture analysis is computed to quantitatively describe the segmented lung nodules. The Frequency spectrum of the lung nodules is developed and its frequency domain features are com-puted. The Complete Local binary pattern of lung nodules is computed in this paper by constructing the combine histogram of Sign and Magnitude Local Binary Patterns. Lo-cal Configuration Pattern is also determined in this work for lung nodules to numeri-cally model the microscopic information of nodules pattern.

  10. Potential contribution of multiplanar reconstruction (MPR) to computer-aided detection of lung nodules on MDCT

    International Nuclear Information System (INIS)

    Matsumoto, Sumiaki; Ohno, Yoshiharu; Yamagata, Hitoshi; Nogami, Munenobu; Kono, Atsushi; Sugimura, Kazuro

    2012-01-01

    Purpose: To evaluate potential benefits of using multiplanar reconstruction (MPR) in computer-aided detection (CAD) of lung nodules on multidetector computed tomography (MDCT). Materials and methods: MDCT datasets of 60 patients with suspected lung nodules were retrospectively collected. Using “second-read” CAD, two radiologists (Readers 1 and 2) independently interpreted these datasets for the detection of non-calcified nodules (≥4 mm) with concomitant confidence rating. They did this task twice, first without MPR (using only axial images), and then 4 weeks later with MPR (using also coronal and sagittal MPR images), where the total reading time per dataset, including the time taken to assess the detection results of CAD software (CAD assessment time), was recorded. The total reading time and CAD assessment time without MPR and those with MPR were statistically compared for each reader. The radiologists’ performance for detecting nodules without MPR and the performance with MPR were compared using jackknife free-response receiver operating characteristic (JAFROC) analysis. Results: Compared to the CAD assessment time without MPR (mean, 69 s and 57 s for Readers 1 and 2), the CAD assessment time with MPR (mean, 46 s and 45 s for Readers 1 and 2) was significantly reduced (P < 0.001). For Reader 1, the total reading time was also significantly shorter in the case with MPR. There was no significant difference between the detection performances without MPR and with MPR. Conclusion: The use of MPR has the potential to improve the workflow in CAD of lung nodules on MDCT.

  11. AUTOMATIC LUNG NODULE DETECTION BASED ON STATISTICAL REGION MERGING AND SUPPORT VECTOR MACHINES

    Directory of Open Access Journals (Sweden)

    Elaheh Aghabalaei Khordehchi

    2017-06-01

    Full Text Available Lung cancer is one of the most common diseases in the world that can be treated if the lung nodules are detected in their early stages of growth. This study develops a new framework for computer-aided detection of pulmonary nodules thorough a fully-automatic analysis of Computed Tomography (CT images. In the present work, the multi-layer CT data is fed into a pre-processing step that exploits an adaptive diffusion-based smoothing algorithm in which the parameters are automatically tuned using an adaptation technique. After multiple levels of morphological filtering, the Regions of Interest (ROIs are extracted from the smoothed images. The Statistical Region Merging (SRM algorithm is applied to the ROIs in order to segment each layer of the CT data. Extracted segments in consecutive layers are then analyzed in such a way that if they intersect at more than a predefined number of pixels, they are labeled with a similar index. The boundaries of the segments in adjacent layers which have the same indices are then connected together to form three-dimensional objects as the nodule candidates. After extracting four spectral, one morphological, and one textural feature from all candidates, they are finally classified into nodules and non-nodules using the Support Vector Machine (SVM classifier. The proposed framework has been applied to two sets of lung CT images and its performance has been compared to that of nine other competing state-of-the-art methods. The considerable efficiency of the proposed approach has been proved quantitatively and validated by clinical experts as well.

  12. Development and validation of a prediction model for measurement variability of lung nodule volumetry in patients with pulmonary metastases.

    Science.gov (United States)

    Hwang, Eui Jin; Goo, Jin Mo; Kim, Jihye; Park, Sang Joon; Ahn, Soyeon; Park, Chang Min; Shin, Yeong-Gil

    2017-08-01

    To develop a prediction model for the variability range of lung nodule volumetry and validate the model in detecting nodule growth. For model development, 50 patients with metastatic nodules were prospectively included. Two consecutive CT scans were performed to assess volumetry for 1,586 nodules. Nodule volume, surface voxel proportion (SVP), attachment proportion (AP) and absolute percentage error (APE) were calculated for each nodule and quantile regression analyses were performed to model the 95% percentile of APE. For validation, 41 patients who underwent metastasectomy were included. After volumetry of resected nodules, sensitivity and specificity for diagnosis of metastatic nodules were compared between two different thresholds of nodule growth determination: uniform 25% volume change threshold and individualized threshold calculated from the model (estimated 95% percentile APE). SVP and AP were included in the final model: Estimated 95% percentile APE = 37.82 · SVP + 48.60 · AP-10.87. In the validation session, the individualized threshold showed significantly higher sensitivity for diagnosis of metastatic nodules than the uniform 25% threshold (75.0% vs. 66.0%, P = 0.004) CONCLUSION: Estimated 95% percentile APE as an individualized threshold of nodule growth showed greater sensitivity in diagnosing metastatic nodules than a global 25% threshold. • The 95 % percentile APE of a particular nodule can be predicted. • Estimated 95 % percentile APE can be utilized as an individualized threshold. • More sensitive diagnosis of metastasis can be made with an individualized threshold. • Tailored nodule management can be provided during nodule growth follow-up.

  13. Automated detection of lung nodules in low-dose computed tomography

    International Nuclear Information System (INIS)

    Cascio, D.; Cheran, S.C.; Chincarini, A.; De Nunzio, G.; Delogu, P.; Fantacci, M.E.; Gargano, G.; Gori, I.; Retico, A.; Masala, G.L.; Preite Martinez, A.; Santoro, M.; Spinelli, C.; Tarantino, T.

    2007-01-01

    A computer-aided detection (CAD) system for the identification of pulmonary nodules in low-dose multi-detector computed-tomography (CT) images has been developed in the framework of the MAGIC-5 Italian project. One of the main goals of this project is to build a distributed database of lung CT scans in order to enable automated image analysis through a data and cpu GRID infrastructure. The basic modules of our lung-CAD system, consisting in a 3D dot-enhancement filter for nodule detection and a neural classifier for false-positive finding reduction, are described. The system was designed and tested for both internal and sub-pleural nodules. The database used in this study consists of 17 low-dose CT scans reconstructed with thin slice thickness (∝300 slices/scan). The preliminary results are shown in terms of the FROC analysis reporting a good sensitivity (85% range) for both internal and sub-pleural nodules at an acceptable level of false positive findings (1-9 FP/scan); the sensitivity value remains very high (75% range) even at 1-6 FP/scan. (orig.)

  14. Optimization of a tomosynthesis system for the detection of lung nodules

    International Nuclear Information System (INIS)

    Pineda, Angel R.; Yoon, Sungwon; Paik, David S.; Fahrig, Rebecca

    2006-01-01

    Mathematical observers that track human performance can be used to reduce the number of human observer studies needed to optimize imaging systems. The performance of human observers for the detection of a 3.6 mm lung nodule in anatomical backgrounds was measured as a function of varying tomosynthetic angle and compared with mathematical observers. The human observer results showed a dramatic increase in the percent of correct responses, from 80% in the projection images to 96% in the projection images with a tomosynthetic angle of just 3 degrees. This result suggests the potential usefulness of the scanned beam digital x-ray system for this application. Given the small number of images (40) used per tomosynthetic angle and the highly nonstationary statistical nature of the backgrounds, the nonprewhitening eye observer achieved a higher performance than the channelized Hotelling observer using a Laguerre-Gauss basis. The channelized Hotelling observer with internal noise and the eye filter matched to the projection data were shown to track human performance as the tomosynthetic angle changed. The validation of these mathematical observers extends their applicability to the optimization of tomosynthesis systems

  15. Using YOLO based deep learning network for real time detection and localization of lung nodules from low dose CT scans

    Science.gov (United States)

    Ramachandran S., Sindhu; George, Jose; Skaria, Shibon; V. V., Varun

    2018-02-01

    Lung cancer is the leading cause of cancer related deaths in the world. The survival rate can be improved if the presence of lung nodules are detected early. This has also led to more focus being given to computer aided detection (CAD) and diagnosis of lung nodules. The arbitrariness of shape, size and texture of lung nodules is a challenge to be faced when developing these detection systems. In the proposed work we use convolutional neural networks to learn the features for nodule detection, replacing the traditional method of handcrafting features like geometric shape or texture. Our network uses the DetectNet architecture based on YOLO (You Only Look Once) to detect the nodules in CT scans of lung. In this architecture, object detection is treated as a regression problem with a single convolutional network simultaneously predicting multiple bounding boxes and class probabilities for those boxes. By performing training using chest CT scans from Lung Image Database Consortium (LIDC), NVIDIA DIGITS and Caffe deep learning framework, we show that nodule detection using this single neural network can result in reasonably low false positive rates with high sensitivity and precision.

  16. CT Fluoroscopy-Guided Core Biopsy for Diagnosis of Small ({<=} 20 mm) Pulmonary Nodules

    Energy Technology Data Exchange (ETDEWEB)

    Lee, Hye Larn; Kim, Yoon Kyung; Woo, Ok Hee; Yong, Hwan Seok; Kang, Eun Young [Dept. of Radiology, Korea University Guro Hospital, Korea University College of Medicine, Seoul (Korea, Republic of); Kim, Hyun Koo [Dept. of Thoracic Surgery, Korea University Guro Hospital, Korea University College of Medicine, Seoul (Korea, Republic of); Shin, Bong Kyung [Dept. of Pathology, Korea University Guro Hospital, Korea University College of Medicine, Seoul (Korea, Republic of)

    2011-10-15

    To evaluate the efficacy of CT fluoroscopy-guided core biopsy of small pulmonary nodules. This study included 62 patients (35 men, 27 women; age range, 36-85 years) that had a small ({<=} 20 mm) pulmonary nodule and underwent CT fluoroscopy-guided core biopsy. The overall diagnostic accuracy and complication rate were calculated. The diagnostic accuracy was compared between two groups according to the nodule size ({<=} 10 mm vs. > 10 mm), and nodule density (solid vs. subsolid). Malignant or premalignant lesions were finally diagnosed in 39 patients; 36 true-positive and three false-negative findings (sensitivity, 92%). A benign lesion was finally diagnosed in 23 patients, with no false-positive results (specificity, 100%). The overall diagnostic accuracy was 95%. The sensitivity and diagnostic accuracy were 85% and 91% for nodules {<=} 10 mm, and 96% and 97% for nodules > 10 mm (p > 0.05). The sensitivity and diagnostic accuracy were 93% and 96% in the solid group and 90% and 92% in the subsolid group (p > 0.05). Seventeen (27%) patients had a pneumothorax and two (3%) required a closed thoracostomy. CT fluoroscopy-guided core biopsy of small pulmonary nodules yields high diagnostic accuracy with acceptable complication rates.

  17. CT-guided marking of pulmonary nodules with a special lung marking wire before video-assisted thoracoscopic surgery. Review of 184 cases; CT-gestuetzte Drahtmarkierung vor videoassistierter thorakoskopischer OP von pulmonalen Rundherden. Eine Auswertung von 184 Faellen

    Energy Technology Data Exchange (ETDEWEB)

    Schulze, M.K.; Eichfeld, U.; Kahn, T.; Stumpp, P. [Universitaetsklinikum Leipzig AoeR (Germany). Klinik und Poliklinik fuer Diagnostische und Interventionelle Radiologie

    2012-06-15

    Purpose: Minimally invasive techniques like video-assisted thoracoscopic surgery (VATS) are currently the method of choice for the resection of small pulmonary nodules, when they are located in the periphery of the lungs. To guarantee quick and safe intraoperative identification of the nodule, preoperative marking is necessary and sensible. We report about our experiences in 184 markings with a special lung marking wire, which is placed in or around the pulmonary nodule using CT guidance. Materials and Methods: In 184 patients (97 m, 87f, mean age: 58.1 {+-} 13.7 years) with pulmonary nodules, scheduled for resection with VATS, a special lung marking wire was placed preoperatively under CT guidance. We evaluated the technical success, safety, necessity of conversion to thoracotomy and histology in all patients. Results: The marking wire could be positioned successfully in 181 cases (98.4 %). There was one major complication (uncontrollable pneumothorax). Minor adverse events like small pneumothorax (53.3 %) or a perifocal bleeding (30.4 %) did not necessitate treatment. Complete resection of the marked nodule was successful in 98.4 % of the patients. Conversion to thoracotomy was necessary in 29 patients (15.9 %) due to bleeding, adhesions, malignancy or wire dislocation. Histology revealed a benign nodule in 96 cases (54.4 %) and a malignant lesion in 78 cases (45.6 %), of which only 21 nodules (11.5 %) turned out to present a primary pulmonary carcinoma. Conclusion: CT-guided marking of pulmonary nodules using a special marking wire followed by thoracoscopic resection is an efficient and safe method for diagnosing suspicious nodules in the periphery of the lung. (orig.)

  18. Clinical evaluation of a software for automated localization of lung nodules at follow-up CT examinations

    International Nuclear Information System (INIS)

    Beyer, F.; Wormanns, D.; Heindel, W.; Kohl, G.

    2004-01-01

    Purpose: To evaluate a software algorithm for automated localization of pulmonary nodules at follow-up CT examinations of the chest and to determine factors influencing the rate of correctly matched nodules. Materials and Methods: The 'real-time automatic matching' (RAM) algorithm (Siemens LungCare TM software) was applied to 22 follow-up multirow-detector CT (MDCT) examinations in 11 patients (Siemens Somatom VolumeZoom, tube voltage 120 kVp; effective tube current 20 mAs (n=18) or 100 mAs (n=4); 4 x 1 mm detector configuration, 1.25 mm slice thickness; 0.8 mm reconstruction increment; standard lung kernel B50f) with a total of 190 lung nodules (mean diameter 6.7±3.5 mm, range 2-17 mm). The following nodule features were recorded: diameter, edge definition (well- or ill-defined), location (upper, middle or lower third; central or peripheral; right of left lung) and inspiration level (considered identical if the difference of diaphragm-apex distance between baseline and follow-up examination was 2 -test was used to describe influence of nodule features on detection rate. Influence of nodule size was assessed using Mann-Whitney-U-Test. Results: RAM correctly located 164 of 190 of all lung nodules (86.3%). Detection rate did not depend on nodule location (left vs. right lung: p=0.48; upper vs. middle vs. lower third: p=0.96; peripheral vs. central: p=0.47) or diameter (p=0.30). Influence of inspiration level was highly significant (p [de

  19. Variability in CT lung-nodule volumetry: Effects of dose reduction and reconstruction methods.

    Science.gov (United States)

    Young, Stefano; Kim, Hyun J Grace; Ko, Moe Moe; Ko, War War; Flores, Carlos; McNitt-Gray, Michael F

    2015-05-01

    Measuring the size of nodules on chest CT is important for lung cancer staging and measuring therapy response. 3D volumetry has been proposed as a more robust alternative to 1D and 2D sizing methods. There have also been substantial advances in methods to reduce radiation dose in CT. The purpose of this work was to investigate the effect of dose reduction and reconstruction methods on variability in 3D lung-nodule volumetry. Reduced-dose CT scans were simulated by applying a noise-addition tool to the raw (sinogram) data from clinically indicated patient scans acquired on a multidetector-row CT scanner (Definition Flash, Siemens Healthcare). Scans were simulated at 25%, 10%, and 3% of the dose of their clinical protocol (CTDIvol of 20.9 mGy), corresponding to CTDIvol values of 5.2, 2.1, and 0.6 mGy. Simulated reduced-dose data were reconstructed with both conventional filtered backprojection (B45 kernel) and iterative reconstruction methods (SAFIRE: I44 strength 3 and I50 strength 3). Three lab technologist readers contoured "measurable" nodules in 33 patients under each of the different acquisition/reconstruction conditions in a blinded study design. Of the 33 measurable nodules, 17 were used to estimate repeatability with their clinical reference protocol, as well as interdose and inter-reconstruction-method reproducibilities. The authors compared the resulting distributions of proportional differences across dose and reconstruction methods by analyzing their means, standard deviations (SDs), and t-test and F-test results. The clinical-dose repeatability experiment yielded a mean proportional difference of 1.1% and SD of 5.5%. The interdose reproducibility experiments gave mean differences ranging from -5.6% to -1.7% and SDs ranging from 6.3% to 9.9%. The inter-reconstruction-method reproducibility experiments gave mean differences of 2.0% (I44 strength 3) and -0.3% (I50 strength 3), and SDs were identical at 7.3%. For the subset of repeatability cases, inter

  20. Localized thin-section CT with radiomics feature extraction and machine learning to classify early-detected pulmonary nodules from lung cancer screening

    Science.gov (United States)

    Tu, Shu-Ju; Wang, Chih-Wei; Pan, Kuang-Tse; Wu, Yi-Cheng; Wu, Chen-Te

    2018-03-01

    Lung cancer screening aims to detect small pulmonary nodules and decrease the mortality rate of those affected. However, studies from large-scale clinical trials of lung cancer screening have shown that the false-positive rate is high and positive predictive value is low. To address these problems, a technical approach is greatly needed for accurate malignancy differentiation among these early-detected nodules. We studied the clinical feasibility of an additional protocol of localized thin-section CT for further assessment on recalled patients from lung cancer screening tests. Our approach of localized thin-section CT was integrated with radiomics features extraction and machine learning classification which was supervised by pathological diagnosis. Localized thin-section CT images of 122 nodules were retrospectively reviewed and 374 radiomics features were extracted. In this study, 48 nodules were benign and 74 malignant. There were nine patients with multiple nodules and four with synchronous multiple malignant nodules. Different machine learning classifiers with a stratified ten-fold cross-validation were used and repeated 100 times to evaluate classification accuracy. Of the image features extracted from the thin-section CT images, 238 (64%) were useful in differentiating between benign and malignant nodules. These useful features include CT density (p  =  0.002 518), sigma (p  =  0.002 781), uniformity (p  =  0.032 41), and entropy (p  =  0.006 685). The highest classification accuracy was 79% by the logistic classifier. The performance metrics of this logistic classification model was 0.80 for the positive predictive value, 0.36 for the false-positive rate, and 0.80 for the area under the receiver operating characteristic curve. Our approach of direct risk classification supervised by the pathological diagnosis with localized thin-section CT and radiomics feature extraction may support clinical physicians in determining

  1. Efficacy of thyroid ultrasound elastography in differential diagnosis of small thyroid nodules

    Energy Technology Data Exchange (ETDEWEB)

    Dighe, Manjiri, E-mail: dighe@u.washington.edu [Department of Radiology, Box 357115, 1959 NE Pacific Street, University of Washington, Seattle, WA 98195 (United States); Luo, Si [Department of Bioengineering, University of Washington, William H. Foege Building, N510B, 3720 15th Ave NE, Seattle, WA 98195-5061 (United States); Cuevas, Carlos, E-mail: cuevas@u.washington.edu [Department of Radiology, Box 357115, 1959 NE Pacific Street, University of Washington, Seattle, WA 98195 (United States); Kim, Yongmin, E-mail: ykim@u.washington.edu [Department of Bioengineering, University of Washington, Box 355061, Seattle, WA 98195-5061 (United States)

    2013-06-15

    Objective: To explore the efficacy of thyroid ultrasound (US) elastography in differential diagnosis of small thyroid nodules. Methods: This HIPAA-compliant study was approved by the Institutional Review Board and all patients provided written informed consent. Thirty-five patients with 38 small thyroid nodules as seen on transverse ultrasound image formed our study population. An US examination and a separate thyroid elastography examination with pulsation from the carotid artery used as the compression source were performed before fine-needle aspiration. Baseband US data were acquired for off-line elastography processing, where a semi-quantitative index for each nodule was calculated. The Kruskal–Wallis nonparametric rank sum test was used to assess equality of population means among the different types of thyroid nodules. Maximum likelihood estimation of the curve parameters for a binomial receiver operating characteristic (ROC) curve was performed. Results: Elasticity contrast index calculated with elastography was effective in distinguishing between small papillary thyroid carcinomas (PTMC, n = 8) and other lesions (n = 30) in small thyroid nodules (p = 0.0036). The area under the ROC curve for diagnosing PTMCs was 0.812 with a 95% confidence interval of 0.653–0.920. The cut-off value of ECI of 3.6 led to a sensitivity of 100% and a specificity of 60% for detecting PTMCs. Conclusion: Noninvasive evaluation of small thyroid nodules is possible using thyroid US elastography with in vivo compression to pick out the most suspicious thyroid nodules for fine-needle aspiration (FNA) and avoid FNA in benign nodules.

  2. Management of an incidentally discovered pulmonary nodule

    International Nuclear Information System (INIS)

    Beigelman-Aubry, Catherine; Hill, Catherine; Grenier, Philippe A.

    2007-01-01

    The incidental finding of a pulmonary nodule on computed tomography (CT) is becoming an increasingly frequent event. The discovery of such a nodule should evoke the possibility of a small bronchogenic carcinoma, for which excision is indicated without delay. However, invasive diagnostic procedures should be avoided in the case of a benign lesion. The objectives of this review article are: (1) to analyze the CT criteria defining benign nodules, nodules of high suspicion of malignancy and indeterminate nodules, (2) to analyze the diagnostic performances and limitations of complementary investigations requested to characterize indeterminate lung nodules, (3) to review the criteria permitting to assess the probability of malignancy of indeterminate nodules and (4) to report on the new guidelines provided by the Fleischner Society for the management of small indeterminate pulmonary nodules, according to their prior probability of malignancy. (orig.)

  3. Small lung neoplasms with growing attitude of alveolar lining. CT-pathologic correlation

    Energy Technology Data Exchange (ETDEWEB)

    Nozawa, Kumiko; Kuramochi, Masashi; Nakajima, Kotaro; Doi, Mikio; Endo, Katsuyuki [Hitachi General Hospital, Ibaraki (Japan); Saida, Yukihisa; Itai, Yuji

    2000-01-01

    The article correlates CT and pathologic findings in 25 lung nodules with ground glass attenuation, which are small than 2 cm in diameter. They includes adenocarcinomas (Noguchi's classification type A, B, C) and a typical adenomatous hyperplasia. (author)

  4. Automated detection of lung nodules with three-dimensional convolutional neural networks

    Science.gov (United States)

    Pérez, Gustavo; Arbeláez, Pablo

    2017-11-01

    Lung cancer is the cancer type with highest mortality rate worldwide. It has been shown that early detection with computer tomography (CT) scans can reduce deaths caused by this disease. Manual detection of cancer nodules is costly and time-consuming. We present a general framework for the detection of nodules in lung CT images. Our method consists of the pre-processing of a patient's CT with filtering and lung extraction from the entire volume using a previously calculated mask for each patient. From the extracted lungs, we perform a candidate generation stage using morphological operations, followed by the training of a three-dimensional convolutional neural network for feature representation and classification of extracted candidates for false positive reduction. We perform experiments on the publicly available LIDC-IDRI dataset. Our candidate extraction approach is effective to produce precise candidates with a recall of 99.6%. In addition, false positive reduction stage manages to successfully classify candidates and increases precision by a factor of 7.000.

  5. 3D multi-view convolutional neural networks for lung nodule classification

    Science.gov (United States)

    Kang, Guixia; Hou, Beibei; Zhang, Ningbo

    2017-01-01

    The 3D convolutional neural network (CNN) is able to make full use of the spatial 3D context information of lung nodules, and the multi-view strategy has been shown to be useful for improving the performance of 2D CNN in classifying lung nodules. In this paper, we explore the classification of lung nodules using the 3D multi-view convolutional neural networks (MV-CNN) with both chain architecture and directed acyclic graph architecture, including 3D Inception and 3D Inception-ResNet. All networks employ the multi-view-one-network strategy. We conduct a binary classification (benign and malignant) and a ternary classification (benign, primary malignant and metastatic malignant) on Computed Tomography (CT) images from Lung Image Database Consortium and Image Database Resource Initiative database (LIDC-IDRI). All results are obtained via 10-fold cross validation. As regards the MV-CNN with chain architecture, results show that the performance of 3D MV-CNN surpasses that of 2D MV-CNN by a significant margin. Finally, a 3D Inception network achieved an error rate of 4.59% for the binary classification and 7.70% for the ternary classification, both of which represent superior results for the corresponding task. We compare the multi-view-one-network strategy with the one-view-one-network strategy. The results reveal that the multi-view-one-network strategy can achieve a lower error rate than the one-view-one-network strategy. PMID:29145492

  6. Lung nodule assessment in computed tomography. Precision of attenuation measurement based on computer-aided volumetry

    International Nuclear Information System (INIS)

    Knoess, Naomi; Hoffmann, B.; Fabel, M.; Wiese, C.; Bolte, H.; Heller, M.; Biederer, J.; Jochens, A.

    2009-01-01

    Purpose: to compare the reproducibility (r) of CT value measurement of pulmonary nodules using volumetry software (LungCare, LC) and manual ROIs (mROI). Materials and methods: 54 artificial nodules in a chest phantom were scanned three times with CT. CT values were measured with LC and mROI. The intrascan-r was assessed with three measurements in the first scan, and the interscan-r with measurements in three consecutive scans (one observer). Intrascan-r und interobserver-r (two obs.) were assessed in the first scan and in contrast-enhanced CT of 51 nodules from 15 patients (kernels b50f and b80f). Intrascan-r and interscan-r were described as the mean range and interobserver-r as the mean difference of CT values. The significance of differences was tested using t-test and sign test. Results: reproducibility was significantly higher for volumetry-based measurements in both artificial and patient nodules (range 0.11 vs. 6.16 HU for intrascan-r, 2.22 vs. 7.03 HU for interscan-r, difference 0.11 vs. 18.42 HU for interobserver-r; patients: 1.78 vs. 13.19 HU (b50f-Kernel) and 1.88 vs. 27.4 HU (b80f-Kernel) for intrascan-r, 3.71 vs. 22.43 HU for interobserver-r). Absolute CT values differed significantly between convolution kernels (pat./mROI: 29.3 [b50f] and 151.9 HU [b80f] pat./LC: 5 [b50f] and 147 HU [b80f]). Conclusion: the reproducibility of volumetry-based measurements of CT values in pulmonary nodules is significantly higher and should therefore be recommended, e.g. in dynamic chest CT protocols. Reproducibility does not depend on absolute CT values. (orig.)

  7. Novel penalised likelihood reconstruction of PET in the assessment of histologically verified small pulmonary nodules

    International Nuclear Information System (INIS)

    Teoh, Eugene J.; Gleeson, Fergus V.; McGowan, Daniel R.; Bradley, Kevin M.; Belcher, Elizabeth; Black, Edward

    2016-01-01

    Investigate the effect of a novel Bayesian penalised likelihood (BPL) reconstruction algorithm on analysis of pulmonary nodules examined with 18F-FDG PET/CT, and to determine its effect on small, sub-10-mm nodules. 18F-FDG PET/CTs performed for nodule evaluation in 104 patients (121 nodules) were retrospectively reconstructed using the new algorithm, and compared to time-of-flight ordered subset expectation maximisation (OSEM) reconstruction. Nodule and background parameters were analysed semi-quantitatively and visually. BPL compared to OSEM resulted in statistically significant increases in nodule SUV max (mean 5.3 to 8.1, p < 0.00001), signal-to-background (mean 3.6 to 5.3, p < 0.00001) and signal-to-noise (mean 24 to 41, p < 0.00001). Mean percentage increase in SUV max (%ΔSUV max ) was significantly higher in nodules ≤10 mm (n = 31, mean 73 %) compared to >10 mm (n = 90, mean 42 %) (p = 0.025). Increase in signal-to-noise was higher in nodules ≤10 mm (224 %, mean 12 to 27) compared to >10 mm (165 %, mean 28 to 46). When applying optimum SUV max thresholds for detecting malignancy, the sensitivity and accuracy increased using BPL, with the greatest improvements in nodules ≤10 mm. BPL results in a significant increase in signal-to-background and signal-to-noise compared to OSEM. When semi-quantitative analyses to diagnose malignancy are applied, higher SUV max thresholds may be warranted owing to the SUV max increase compared to OSEM. (orig.)

  8. Novel penalised likelihood reconstruction of PET in the assessment of histologically verified small pulmonary nodules

    Energy Technology Data Exchange (ETDEWEB)

    Teoh, Eugene J.; Gleeson, Fergus V. [Oxford University Hospitals NHS Trust, Department of Radiology, Churchill Hospital, Oxford (United Kingdom); University of Oxford, Department of Oncology, Oxford (United Kingdom); McGowan, Daniel R. [University of Oxford, Department of Oncology, Oxford (United Kingdom); Oxford University Hospitals NHS Trust, Radiation Physics and Protection, Churchill Hospital, Oxford (United Kingdom); Bradley, Kevin M. [Oxford University Hospitals NHS Trust, Department of Radiology, Churchill Hospital, Oxford (United Kingdom); Belcher, Elizabeth; Black, Edward [Oxford University Hospitals NHS Trust, Department of Thoracic Surgery, John Radcliffe Hospital, Oxford (United Kingdom)

    2016-02-15

    Investigate the effect of a novel Bayesian penalised likelihood (BPL) reconstruction algorithm on analysis of pulmonary nodules examined with 18F-FDG PET/CT, and to determine its effect on small, sub-10-mm nodules. 18F-FDG PET/CTs performed for nodule evaluation in 104 patients (121 nodules) were retrospectively reconstructed using the new algorithm, and compared to time-of-flight ordered subset expectation maximisation (OSEM) reconstruction. Nodule and background parameters were analysed semi-quantitatively and visually. BPL compared to OSEM resulted in statistically significant increases in nodule SUV{sub max} (mean 5.3 to 8.1, p < 0.00001), signal-to-background (mean 3.6 to 5.3, p < 0.00001) and signal-to-noise (mean 24 to 41, p < 0.00001). Mean percentage increase in SUV{sub max} (%ΔSUV{sub max}) was significantly higher in nodules ≤10 mm (n = 31, mean 73 %) compared to >10 mm (n = 90, mean 42 %) (p = 0.025). Increase in signal-to-noise was higher in nodules ≤10 mm (224 %, mean 12 to 27) compared to >10 mm (165 %, mean 28 to 46). When applying optimum SUV{sub max} thresholds for detecting malignancy, the sensitivity and accuracy increased using BPL, with the greatest improvements in nodules ≤10 mm. BPL results in a significant increase in signal-to-background and signal-to-noise compared to OSEM. When semi-quantitative analyses to diagnose malignancy are applied, higher SUV{sub max} thresholds may be warranted owing to the SUV{sub max} increase compared to OSEM. (orig.)

  9. Assessing the use of digital radiography and a real-time interactive pulmonary nodule analysis system for large population lung cancer screening

    International Nuclear Information System (INIS)

    Xu Yan; Ma Daqing; He Wen

    2012-01-01

    Rationale and objectives: To assess the use of chest digital radiograph (DR) assisted with a real-time interactive pulmonary nodule analysis system in large population lung cancer screening. Materials and methods: 346 DR/CR patient studies with corresponding CT images were selected from 12,500 patients screened for lung cancer from year 2007 to 2009. Two expert chest radiologists established CT-confirmed Gold Standard of nodules on DR/CR images with consensus. These cases were read by eight other chest radiologists (participating radiologists) first without using a real-time interactive pulmonary nodule analysis system and then re-read using the system. Performances of participating radiologists and the computer system were analyzed. Results: The computer system achieved similar performance on DR and CR images, with a detection rate of 76% and an average FPs of 2.0 per image. Before and after using the computer-aided detection system, the nodule detection sensitivities of the participating radiologists were 62.3% and 77.3% respectively, and the A z values increased from 0.794 to 0.831. Statistical analysis demonstrated statically significant improvement for the participating radiologists after using the computer analysis system with a P-value 0.05. Conclusion: The computer system could help radiologists identify more lesions, especially small ones that are more likely to be overlooked on chest DR/CR images, and could help reduce inter-observer diagnostic variations, while its FPs were easy to recognize and dismiss. It is suggested that DR/CR assisted by the real-time interactive pulmonary nodule analysis system may be an effective means to screen large populations for lung cancer.

  10. Computer-aided detection of small pulmonary nodules in multidetector spiral computed tomography (MSCT) in children

    International Nuclear Information System (INIS)

    Honnef, D.; Behrendt, F.F.; Hohl, C.; Mahnken, A.H.; Guenther, R.W.; Das, M.; Mertens, R.; Stanzel, S.

    2008-01-01

    Purpose: Retrospective evaluation of computer-aided detection software (CAD) for automated detection (LungCAD, Siemens Medical solutions, Forchheim, Germany) and volumetry (LungCARE) of pulmonary nodules in dose-reduced pediatric MDCT. Materials and Methods: 30 scans of 24 children (10.4±5.9 years, 13 girls, 11 boys, 39.7±29.3 kg body weight) were performed on a 16-MDCT for tumor staging (n=18), inflammation (n=9), other indications (n=3). Tube voltage 120 kVp and effective mAs were adapted to body weight. Slice thickness 2 mm, increment 1 mm. A pediatric radiologist (U1), a CAD expert (U2) and an inexperienced radiologist (U3) independently analyzed the lung window images without and with the CAD as a second reader. In a consensus decision U1 and U2 were the reference standard. Results: Five examinations had to be excluded from the study due to other underlying lung disease. A total of 24 pulmonary nodules were found in all data sets with a minimal diameter of 0.35 mm to 3.81 mm (mean 1.7±0.85 mm). The sensitivities were as follows: U1 95.8% and 100% with CAD; U2 91.7% U3 66.7%. U2 and U3 did not detect further nodules with CAD. The sensitivity of CAD alone was 41.7% with 0.32 false-positive findings per examination. Interobserver agreement between U1/U2 regarding nodule detection with CAD was good (k=0.6500) and without CAD very good (k=0.8727). For the rest (U1/U3; U2/U3 with and without CAD), it was weak (k=0.0667-0.1884). Depending on the measured value (axial measurement, volume), there is a significant correlation (p=0.0026-0.0432) between nodule size and CAD detection. Undetected pulmonary nodules (mean 1.35 mm; range 0.35-2.61 mm) were smaller than the detected ones (mean 2.19 mm; range 1.35-3.81 mm). No significant correlation was found between CAD findings and patient age (p=0.9263) and body weight (p=0.9271) as well as nodule location (subpleural, intraparenchymal; p=1.0) and noise/SNR. (orig.)

  11. Evaluation of computer aided volumetry for simulated small pulmonary nodules on computed tomography

    International Nuclear Information System (INIS)

    Do, Kyung Hyun; Goo, Jin Mo; Lee, Kyung Won; Im, Jung Gi; Chung, Myung Jin

    2004-01-01

    To determine the accuracy of automated computer aided volumetry for simulated small pulmonary nodules at computed tomography using various types of phantoms Three sets of synthetic nodules (small, calcified and those adjacent to vessels) were studied. The volume of the nodules in each set was already known, and using multi-slice CT, volumetric data for each nodule was acquired from the three-dimensional reconstructed image. The volume was calculated by applying three different threshold values using Rapidia software (3D-Med, Seoul, Korea). Relative errors in the measured volume of synthetic pulmonary nodules were 17.3, 2.9, and 11.5% at -200, -400, and -600 HU, respectively, and there was good correlation between true volume and measured volume at -400 HU (r=0.96, p<0.001). For calcified nodules, relative errors in measured volume were 10.9, 5.3, and 16.5% at -200, -400, and -600 HU, respectively, and there was good correlation between true volume and measured volume at -400 HU (r=1.03, p<0.001). In cases involving synthetic nodules adjacent to vessels, relative errors were 4.6, 16.3, and 31.2% at -200, -400, and -600 HU, respectively. There was good correlation between true volume and measured volume at -200 HU (r=1.1, p<0.001). Using computer-aided volumetry, the measured volumes of synthetic nodules correlated closely with their true volume. Measured volumes were the same at each threshold level, regardless of window setting

  12. Evaluation of computer aided volumetry for simulated small pulmonary nodules on computed tomography

    International Nuclear Information System (INIS)

    Goo, Jin Mo; Lee, Kyung Won; Im, Jung Gi; Do, Kyung Hyun; Chung, Myung Jin

    2004-01-01

    To determine the accuracy of automated computer aided volumetry for simulated small pulmonary nodules at computed tomography using various types of phantoms. Three sets of synthetic nodules (small, calcified and those adjacent to vessels) were studied. The volume of the nodules in each set was already known, and using multi-slice CT, volumetric data for each nodule was acquired from the three-dimensional reconstructed image. The volume was calculated by applying three different threshold values using Rapidia software (3D-Med, Seoul, Korea). Relative errors in the measured volume of synthetic pulmonary nodules were 17.3, 2.9, and 11.5% at -200, -400, and --600 HU, respectively, and there was good correlation between true volume and measured volume at -400 HU (r=0.96, p<0.001). For calcified nodules, relative errors in measured volume were 10.9, 5.3, and 16.5% at -200, -400, and -600 HU, respectively, and there was good correlation between true volume and measured volume at -400 HU (r=1.03, p<0.001). In cases involving synthetic nodules adjacent to vessels, relative errors were 4.6, 16.3, and 31.2 % at -200, -400, and -600 HU, respectively. There was good correlation between true volume and measured volume at -200 HU (r=1.1, p<0.001). Using computer-aided volumetry, the measured volumes of synthetic nodules correlated closely with their true volume. Measured volumes were the same at each threshold level, regardless of window setting

  13. Data-Driven Decision Support for Radiologists: Re-using the National Lung Screening Trial Dataset for Pulmonary Nodule Management

    OpenAIRE

    Morrison, James J.; Hostetter, Jason; Wang, Kenneth; Siegel, Eliot L.

    2014-01-01

    Real-time mining of large research trial datasets enables development of case-based clinical decision support tools. Several applicable research datasets exist including the National Lung Screening Trial (NLST), a dataset unparalleled in size and scope for studying population-based lung cancer screening. Using these data, a clinical decision support tool was developed which matches patient demographics and lung nodule characteristics to a cohort of similar patients. The NLST dataset was conve...

  14. Soft computing approach to 3D lung nodule segmentation in CT.

    Science.gov (United States)

    Badura, P; Pietka, E

    2014-10-01

    This paper presents a novel, multilevel approach to the segmentation of various types of pulmonary nodules in computed tomography studies. It is based on two branches of computational intelligence: the fuzzy connectedness (FC) and the evolutionary computation. First, the image and auxiliary data are prepared for the 3D FC analysis during the first stage of an algorithm - the masks generation. Its main goal is to process some specific types of nodules connected to the pleura or vessels. It consists of some basic image processing operations as well as dedicated routines for the specific cases of nodules. The evolutionary computation is performed on the image and seed points in order to shorten the FC analysis and improve its accuracy. After the FC application, the remaining vessels are removed during the postprocessing stage. The method has been validated using the first dataset of studies acquired and described by the Lung Image Database Consortium (LIDC) and by its latest release - the LIDC-IDRI (Image Database Resource Initiative) database. Copyright © 2014 Elsevier Ltd. All rights reserved.

  15. Diagnostic feasibility and safety of CT-guided core biopsy for lung nodules less than or equal to 8 mm. A single-institution experience

    Energy Technology Data Exchange (ETDEWEB)

    Chang, Ying-Yueh [Taipei Veterans General Hospital, Department of Radiology, Taipei (China); Chen, Chun-Ku [Taipei Veterans General Hospital, Department of Radiology, Taipei (China); National Yang-Ming University, School of Medicine, Taipei (China); National Yang-Ming University, Institute of Clinical Medicine, Taipei (China); Yeh, Yi-Chen [National Yang-Ming University, School of Medicine, Taipei (China); Taipei Veterans General Hospital, Department of Pathology and Laboratory Medicine, Taipei (China); Wu, Mei-Han [Taipei Veterans General Hospital, Department of Radiology, Taipei (China); National Yang-Ming University, School of Medicine, Taipei (China)

    2018-02-15

    This retrospective study evaluated the diagnostic yield and safety of CT-guided core biopsy of pulmonary nodules ≤8 mm. We determined the diagnostic yield and safety profile of CT-guided lung biopsies for 125 pulmonary nodules ≤8 mm. Pathological diagnoses were made by a combination of histopathological examination and imprint cytology. Results were compared with biopsy results for 134 pulmonary nodules >8 and ≤10 mm. Final diagnoses were established in 94 nodules ≤8 mm. The sensitivity, specificity and diagnostic accuracy of CT-guided core biopsy for nodules ≤8 mm were 87.1 % (61/70 nodules), 100 % (24/24) and 90.4 % (85/94), respectively. Diagnostic failure rates were comparable for nodules ≤8 mm and nodules >8 mm and ≤10 mm (9/94, 9.6 % and 7/111, 6.3 %, respectively, P=0.385). The rate of tube thoracostomy for nodules ≤8 mm was comparable to that for nodules >8 and ≤10 mm (1.6 % vs. 0.7 %, P=0.611). Nodules ≤6 mm had a higher non-diagnostic result rate of 15.4 % (6/39) than did nodules >8 and ≤10 mm (3.7 %, 5/134, P=0.017). CT-guided pulmonary biopsy is feasible for lung nodules ≤8 mm, especially those >6 mm, and has an acceptable diagnostic yield and safety profile. (orig.)

  16. Improvement in visibility of simulated lung nodules on computed radiography (CR) chest images by use of temporal subtraction technique

    International Nuclear Information System (INIS)

    Oda, Nobuhiro; Fujimoto, Keiji; Murakami, Seiichi; Katsuragawa, Shigehiko; Doi, Kunio; Nakata, Hajime

    1999-01-01

    A temporal subtraction image obtained by subtraction of a previous image from a current one can enhance interval change on chest images. In this study, we compared the visibility of simulated lung nodules on CR images with and without temporal subtraction. Chest phantom images without and with simulated nodules were obtained as previous and current images, respectively, by a CR system. Then, subtraction images were produced with an iterative image warping technique. Twelve simulated nodules were attached on various locations of the chest phantom. The diameter of nodules having a CT number of 47 ranged from 3 mm to 10 mm. Seven radiologists subjectively evaluated the visibility of simulated nodules on CR images with and without temporal subtraction using a three-point rating scale (0: invisible, +1: questionable, +2:visible). The minimum diameter of simulated nodules visible at a frequency greater than 50% was 4 mm on the CR images with temporal subtraction and 6 mm on those without. Our results indicated that the subtraction images clearly improved the visibility of simulated nodules. (author)

  17. Small nodule detectability evaluation using a generalized scan-statistic model

    International Nuclear Information System (INIS)

    Popescu, Lucretiu M; Lewitt, Robert M

    2006-01-01

    In this paper is investigated the use of the scan statistic for evaluating the detectability of small nodules in medical images. The scan-statistic method is often used in applications in which random fields must be searched for abnormal local features. Several results of the detection with localization theory are reviewed and a generalization is presented using the noise nodule distribution obtained by scanning arbitrary areas. One benefit of the noise nodule model is that it enables determination of the scan-statistic distribution by using only a few image samples in a way suitable both for simulation and experimental setups. Also, based on the noise nodule model, the case of multiple targets per image is addressed and an image abnormality test using the likelihood ratio and an alternative test using multiple decision thresholds are derived. The results obtained reveal that in the case of low contrast nodules or multiple nodules the usual test strategy based on a single decision threshold underperforms compared with the alternative tests. That is a consequence of the fact that not only the contrast or the size, but also the number of suspicious nodules is a clue indicating the image abnormality. In the case of the likelihood ratio test, the multiple clues are unified in a single decision variable. Other tests that process multiple clues differently do not necessarily produce a unique ROC curve, as shown in examples using a test involving two decision thresholds. We present examples with two-dimensional time-of-flight (TOF) and non-TOF PET image sets analysed using the scan statistic for different search areas, as well as the fixed position observer

  18. Dynamic Gd-DTPA enhanced breath-hold 1.5 t MRI of normal lungs and patients with interstitial lung disease and pulmonary nodules: preliminary results

    International Nuclear Information System (INIS)

    Semelka, R.C.; Maycher, B.; Shoenut, J.P.; Kroeker, R.; Griffin, P.; Lertzman, M.

    1992-01-01

    A FLASH technique was used, which encompassed the entire thorax in the transverse plane, before and after dynamic intravenous injection of godalinium DTPA (Gd-DTPA) to study 7 patients with normal lungs, 12 patients with interstitial lung disease (ILD), and 11 patients with pulmonary nodules. Comparative CT studies were obtained within 2 weeks of the MRI study in the patients with lung disease. Quantitative signal intensity (SI) measurements were performed. Qualitative evaluation of lung parenchyma was determined in a prospective blinded fashion, and in the normal group comparison was made with the CT images. In normal patients, SI of lung parenchyma increased by 7.7±1.3%. On precontrast images, second-order pulmonary branchings were visible while post-contrast, fifth- to sixth-order branches were apparent. In patients with ILD, interstitial changes enhanced to a variable extent, increases in SI ranging from minimal (49.9%) to substantial (308.4%). Detection of pulmonary nodules improved following contrast injection. The minimum lesion size detectable decreased from 8 mm precontrast to 5 mm post-contrast. Percentage contrast enhancement was greater for malignant nodules (124.2±79.7%) than benign nodules (5.8±4.7%) (p<0.01). (orig.)

  19. Computer-aided detection of lung nodules via 3D fast radial transform, scale space representation, and Zernike MIP classification.

    Science.gov (United States)

    Riccardi, Alessandro; Petkov, Todor Sergueev; Ferri, Gianluca; Masotti, Matteo; Campanini, Renato

    2011-04-01

    The authors presented a novel system for automated nodule detection in lung CT exams. The approach is based on (1) a lung tissue segmentation preprocessing step, composed of histogram thresholding, seeded region growing, and mathematical morphology; (2) a filtering step, whose aim is the preliminary detection of candidate nodules (via 3D fast radial filtering) and estimation of their geometrical features (via scale space analysis); and (3) a false positive reduction (FPR) step, comprising a heuristic FPR, which applies thresholds based on geometrical features, and a supervised FPR, which is based on support vector machines classification, which in turn, is enhanced by a feature extraction algorithm based on maximum intensity projection processing and Zernike moments. The system was validated on 154 chest axial CT exams provided by the lung image database consortium public database. The authors obtained correct detection of 71% of nodules marked by all radiologists, with a false positive rate of 6.5 false positives per patient (FP/patient). A higher specificity of 2.5 FP/patient was reached with a sensitivity of 60%. An independent test on the ANODE09 competition database obtained an overall score of 0.310. The system shows a novel approach to the problem of lung nodule detection in CT scans: It relies on filtering techniques, image transforms, and descriptors rather than region growing and nodule segmentation, and the results are comparable to those of other recent systems in literature and show little dependency on the different types of nodules, which is a good sign of robustness.

  20. Toxocariasis masquerading as liver and lung metastatic nodules in patents with gastrointestinal cancer: clinicopathologic study of five cases.

    Science.gov (United States)

    Park, Sanghui; Kim, Yun Soo; Kim, Yu Jin; Kyung, Sun Young; Park, Jeong-Woong; Jeong, Sung Hwan; Lee, Sang Pyo

    2012-01-01

    There are sporadic reports in the literature in which radiologic liver and lung lesions found incidentally during follow-up metastatic surveillance were shown to be caused by toxocariasis. The objective of the work discussed in this report was to identify common clinical and histopathological features of toxocariasis resembling metastatic nodules in five patients with gastrointestinal cancer. We retrospectively analyzed clinical features of five gastrointestinal cancer patients with liver or lung nodules mimicking metastasis. Serologic tests for parasitic infestations and pathologic examinations were performed. All five patients were males and three patients had gastric cancer and two had colorectal cancer. All the cases of toxocariasis were confirmed serologically. On follow-up imaging, the lesions improved or resolved, suggestive of the phenomenon of visceral larva migrans. In two patients, liver biopsy was performed and showed eosinophilic abscess. Serologic tests and liver or lung biopsy should be performed aggressively to exclude toxocariasis when patients with underlying gastrointestinal cancer present with hepatic or pulmonary nodules associated with eosinophilia, particularly if the patients have a clinical history of raw animal liver ingestion. Curative surgical intervention should not be excluded just because of multiple nodules in the liver or the lungs.

  1. Preliminary study of diagnostic workstation with different matrix size for detection of small pulmonary nodules

    International Nuclear Information System (INIS)

    Wu Jie; Wang Xuejian; Wang Bo; Tong Juan; Wei Yuqing; Shen Guiquan; Wang Limei; Cao Jun; Sui He

    2004-01-01

    Objective: To assess the influence in detecting small pulmonary nodules (SPNs) on soft-copy images displayed with different matrix sizes. Methods: Seventy-six chest compute radiographs were selected for the study. Of the 76 test images, 36 pulmonary nodules smaller than 20 mm in diameter were proven by CT, which were further divided into two groups: 1.0-2.0 cm and Z values and standard error of three kinds of view system for individual observers. Results: For 1.0-2.0 cm group, the mean A Z values were 0.7936 for DRCS with 2-fold magnification and window technique, 0.8225 for 1 K monitor with 2-fold magnification and window technique, and 0.8367 for 2 K monitor without magnification; for Z values increased slightly as the display matrix size improved, but there were no significant differences among the three sets in the detection of SPNs in the ROC analyses. Conclusion: It is acceptable to detect small pulmonary nodules of 1.0-2.0 cm in diameter on 1 K monitor and DRCS with magnification. High resolution diagnostic workstation is recommended for detecting small pulmonary nodules <1.0 cm in diameter. Reasonable equipment for the detection of subtle abnormality may result in better cost-efficacy and diagnostic accuracy

  2. Small nodules (1-2 cm) in liver cirrhosis: Characterization with contrast-enhanced ultrasound

    Energy Technology Data Exchange (ETDEWEB)

    Jang, Hyun-Jung [Department of Medical Imaging, Toronto General Hospital, University of Toronto, 585 University Avenue, Toronto, Ontario M5G 2N2 (Canada); Kim, Tae Kyoung [Department of Medical Imaging, Toronto General Hospital, University of Toronto, 585 University Avenue, Toronto, Ontario M5G 2N2 (Canada)], E-mail: taekyoung.kim@uhn.on.ca; Wilson, Stephanie R. [Department of Medical Imaging, Toronto General Hospital, University of Toronto, 585 University Avenue, Toronto, Ontario M5G 2N2 (Canada)

    2009-12-15

    Objective: To determine the diagnostic efficacy of arterial phase contrast-enhanced ultrasound (CEUS) for characterizing small hepatic nodules (1-2 cm) in patients with high-risk for hepatocellular carcinoma (HCC). Materials and methods: Over 12 months, CEUS was performed in 59 patients at high-risk for HCC with small hepatic nodules (1-2 cm; mean, 1.5 cm). Based only on arterial phase (<45 s) vascular intensity and pattern, lesions were prospectively diagnosed as HCC if there was hypervascularity without known features of hemangioma. The diagnosis of HCC was made regardless of the presence or absence of washout. Verification of diagnosis was made by liver transplantation (n = 13), biopsy (n = 12), resection (n = 3) or clinical and imaging follow-up for at least 12 months (n = 31). Results: At of the time of CEUS, the 59 nodules were diagnosed as HCC in 26 and benign lesions in 33, including 20 regenerative/dysplastic nodules (RN/DN), 11 hemangiomas, and 2 focal fat sparing. All 26 nodules with arterial phase hypervascularity without hemangioma-like features were HCC. However, CEUS misdiagnosed HCC as RN/DN in 4 cases with arterial iso- (n = 3) or hypovascularity (n = 1). CEUS correctly diagnosed all 11 hemangiomas. The sensitivity, specificity, and accuracy of CEUS for diagnosing HCC were 86.7, 100, and 93.2%. Conclusions: Arterial phase vascular intensity and pattern of CEUS are highly accurate for the diagnosis of small (1-2 cm) HCC and hemangioma in liver cirrhosis. On CEUS, arterial phase hypervascularity without a hemangioma-pattern alone may be sufficient for diagnosis of small HCC. Infrequent iso/hypovascular HCC may erroneously suggest RN/DN necessitating biopsy or close follow-up.

  3. Roles of computed tomography and [18F]fluorodeoxyglucose-positron emission tomography/computed tomography in the characterization of multiple solitary solid lung nodules

    OpenAIRE

    Travaini, LL; Trifirò, G; Vigna, PD; Veronesi, G; De Pas, TM; Spaggiari, L; Paganelli, G; Bellomi, M

    2012-01-01

    The purpose of this study is to compare the performance of multidetector computed tomography (CT) and positron emission tomography/CT (PET/CT) with [18F]fluorodeoxyglucose in the diagnosis of multiple solitary lung nodules in 14 consecutive patients with suspicious lung cancer. CT and PET/CT findings were reviewed by a radiologist and nuclear medicine physician, respectively, blinded to the pathological diagnoses of lung cancer, considering nodule size, shape, and location (CT) and maximum st...

  4. Comparison of image features calculated in different dimensions for computer-aided diagnosis of lung nodules

    Science.gov (United States)

    Xu, Ye; Lee, Michael C.; Boroczky, Lilla; Cann, Aaron D.; Borczuk, Alain C.; Kawut, Steven M.; Powell, Charles A.

    2009-02-01

    Features calculated from different dimensions of images capture quantitative information of the lung nodules through one or multiple image slices. Previously published computer-aided diagnosis (CADx) systems have used either twodimensional (2D) or three-dimensional (3D) features, though there has been little systematic analysis of the relevance of the different dimensions and of the impact of combining different dimensions. The aim of this study is to determine the importance of combining features calculated in different dimensions. We have performed CADx experiments on 125 pulmonary nodules imaged using multi-detector row CT (MDCT). The CADx system computed 192 2D, 2.5D, and 3D image features of the lesions. Leave-one-out experiments were performed using five different combinations of features from different dimensions: 2D, 3D, 2.5D, 2D+3D, and 2D+3D+2.5D. The experiments were performed ten times for each group. Accuracy, sensitivity and specificity were used to evaluate the performance. Wilcoxon signed-rank tests were applied to compare the classification results from these five different combinations of features. Our results showed that 3D image features generate the best result compared with other combinations of features. This suggests one approach to potentially reducing the dimensionality of the CADx data space and the computational complexity of the system while maintaining diagnostic accuracy.

  5. Radioaerosol lung imaging in small airways disease

    Energy Technology Data Exchange (ETDEWEB)

    Weiss, T; Dorow, P; Felix, R

    1981-06-01

    Aerosol inhalation lung imaging was performed in 35 asymptomatic smokers who have been selected on the basis of abnormal findings in small airways pulmonary function tests. Qualitative (image inspection) and quantitative (aerosol distribution index = ADI) analysis of the radioaerosol lung patterns was accomplished. Compared to healthy subjects as well as to patients with chronic obstructive lung disease significant differences of mean aerosol distribution homogeneity were observed. A characteristic type of abnormal aerosol pattern, indicating peripheral airways obstruction, was found in 71% of the patients with small airways disease.

  6. Clinical, pathological, and radiological characteristics of solitary ground-glass opacity lung nodules on high-resolution computed tomography

    Directory of Open Access Journals (Sweden)

    Qiu ZX

    2016-09-01

    Full Text Available Zhi-Xin Qiu,1 Yue Cheng,1 Dan Liu,1 Wei-Ya Wang,2 Xia Wu,2 Wei-Lu Wu,2 Wei-Min Li1,2 1Department of Respiratory Medicine, 2Department of Pathology, West China Hospital, Sichuan University, Chengdu, People’s Republic of China Background: Lung nodules are being detected at an increasing rate year by year with high-resolution computed tomography (HRCT being widely used. Ground-glass opacity nodule is one of the special types of pulmonary nodules that is confirmed to be closely associated with early stage of lung cancer. Very little is known about solitary ground-glass opacity nodules (SGGNs. In this study, we analyzed the clinical, pathological, and radiological characteristics of SGGNs on HRCT.Methods: A total of 95 resected SGGNs were evaluated with HRCT scan. The clinical, pathological, and radiological characteristics of these cases were analyzed.Results: Eighty-one adenocarcinoma and 14 benign nodules were observed. The nodules included 12 (15% adenocarcinoma in situ (AIS, 14 (17% minimally invasive adenocarcinoma (MIA, and 55 (68% invasive adenocarcinoma (IA. No patients with recurrence till date have been identified. The positive expression rates of anaplastic lymphoma kinase and ROS-1 (proto-oncogene tyrosine-protein kinase ROS were only 2.5% and 8.6%, respectively. The specificity and accuracy of HRCT of invasive lung adenocarcinoma were 85.2% and 87.4%. The standard uptake values of only two patients determined by 18F-FDG positron emission tomography/computed tomography (PET/CT were above 2.5. The size, density, shape, and pleural tag of nodules were significant factors that differentiated IA from AIS and MIA. Moreover, the size, shape, margin, pleural tag, vascular cluster, bubble-like sign, and air bronchogram of nodules were significant determinants for mixed ground-glass opacity nodules (all P<0.05.Conclusion: We analyzed the clinical, pathological, and radiological characteristics of SGGNs on HRCT and found that the size, density

  7. Techniques for virtual lung nodule insertion: volumetric and morphometric comparison of projection-based and image-based methods for quantitative CT

    Science.gov (United States)

    Robins, Marthony; Solomon, Justin; Sahbaee, Pooyan; Sedlmair, Martin; Choudhury, Kingshuk Roy; Pezeshk, Aria; Sahiner, Berkman; Samei, Ehsan

    2017-09-01

    Virtual nodule insertion paves the way towards the development of standardized databases of hybrid CT images with known lesions. The purpose of this study was to assess three methods (an established and two newly developed techniques) for inserting virtual lung nodules into CT images. Assessment was done by comparing virtual nodule volume and shape to the CT-derived volume and shape of synthetic nodules. 24 synthetic nodules (three sizes, four morphologies, two repeats) were physically inserted into the lung cavity of an anthropomorphic chest phantom (KYOTO KAGAKU). The phantom was imaged with and without nodules on a commercial CT scanner (SOMATOM Definition Flash, Siemens) using a standard thoracic CT protocol at two dose levels (1.4 and 22 mGy CTDIvol). Raw projection data were saved and reconstructed with filtered back-projection and sinogram affirmed iterative reconstruction (SAFIRE, strength 5) at 0.6 mm slice thickness. Corresponding 3D idealized, virtual nodule models were co-registered with the CT images to determine each nodule’s location and orientation. Virtual nodules were voxelized, partial volume corrected, and inserted into nodule-free CT data (accounting for system imaging physics) using two methods: projection-based Technique A, and image-based Technique B. Also a third Technique C based on cropping a region of interest from the acquired image of the real nodule and blending it into the nodule-free image was tested. Nodule volumes were measured using a commercial segmentation tool (iNtuition, TeraRecon, Inc.) and deformation was assessed using the Hausdorff distance. Nodule volumes and deformations were compared between the idealized, CT-derived and virtual nodules using a linear mixed effects regression model which utilized the mean, standard deviation, and coefficient of variation (Mea{{n}RHD} , ST{{D}RHD} and C{{V}RHD}{) }~ of the regional Hausdorff distance. Overall, there was a close concordance between the volumes of the CT-derived and

  8. Adaptive statistical iterative reconstruction-applied ultra-low-dose CT with radiography- comparable radiation dose: Usefulness for lung nodule detection

    International Nuclear Information System (INIS)

    Yoon, Hyun Jung; Chung, Myung Jin; Hwang, Hye Sun; Lee, Kyung Soo; Moon, Jung Won

    2015-01-01

    To assess the performance of adaptive statistical iterative reconstruction (ASIR)-applied ultra-low-dose CT (ULDCT) in detecting small lung nodules. Thirty patients underwent both ULDCT and standard dose CT (SCT). After determining the reference standard nodules, five observers, blinded to the reference standard reading results, independently evaluated SCT and both subsets of ASIR- and filtered back projection (FBP)-driven ULDCT images. Data assessed by observers were compared statistically. Converted effective doses in SCT and ULDCT were 2.81 ± 0.92 and 0.17 ± 0.02 mSv, respectively. A total of 114 lung nodules were detected on SCT as a standard reference. There was no statistically significant difference in sensitivity between ASIR-driven ULDCT and SCT for three out of the five observers (p = 0.678, 0.735, < 0.01, 0.038, and < 0.868 for observers 1, 2, 3, 4, and 5, respectively). The sensitivity of FBP-driven ULDCT was significantly lower than that of ASIR-driven ULDCT in three out of the five observers (p < 0.01 for three observers, and p = 0.064 and 0.146 for two observers). In jackknife alternative free-response receiver operating characteristic analysis, the mean values of figure-of-merit (FOM) for FBP, ASIR-driven ULDCT, and SCT were 0.682, 0.772, and 0.821, respectively, and there were no significant differences in FOM values between ASIR-driven ULDCT and SCT (p = 0.11), but the FOM value of FBP-driven ULDCT was significantly lower than that of ASIR-driven ULDCT and SCT (p = 0.01 and 0.00). Adaptive statistical iterative reconstruction-driven ULDCT delivering a radiation dose of only 0.17 mSv offers acceptable sensitivity in nodule detection compared with SCT and has better performance than FBP-driven ULDCT

  9. Adaptive statistical iterative reconstruction-applied ultra-low-dose CT with radiography- comparable radiation dose: Usefulness for lung nodule detection

    Energy Technology Data Exchange (ETDEWEB)

    Yoon, Hyun Jung; Chung, Myung Jin; Hwang, Hye Sun; Lee, Kyung Soo [Dept. of Radiology and Center for Imaging Science, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul (Korea, Republic of); Moon, Jung Won [Dept. of Radiology, Kangbuk Samsung Hospital, Seoul (Korea, Republic of)

    2015-10-15

    To assess the performance of adaptive statistical iterative reconstruction (ASIR)-applied ultra-low-dose CT (ULDCT) in detecting small lung nodules. Thirty patients underwent both ULDCT and standard dose CT (SCT). After determining the reference standard nodules, five observers, blinded to the reference standard reading results, independently evaluated SCT and both subsets of ASIR- and filtered back projection (FBP)-driven ULDCT images. Data assessed by observers were compared statistically. Converted effective doses in SCT and ULDCT were 2.81 ± 0.92 and 0.17 ± 0.02 mSv, respectively. A total of 114 lung nodules were detected on SCT as a standard reference. There was no statistically significant difference in sensitivity between ASIR-driven ULDCT and SCT for three out of the five observers (p = 0.678, 0.735, < 0.01, 0.038, and < 0.868 for observers 1, 2, 3, 4, and 5, respectively). The sensitivity of FBP-driven ULDCT was significantly lower than that of ASIR-driven ULDCT in three out of the five observers (p < 0.01 for three observers, and p = 0.064 and 0.146 for two observers). In jackknife alternative free-response receiver operating characteristic analysis, the mean values of figure-of-merit (FOM) for FBP, ASIR-driven ULDCT, and SCT were 0.682, 0.772, and 0.821, respectively, and there were no significant differences in FOM values between ASIR-driven ULDCT and SCT (p = 0.11), but the FOM value of FBP-driven ULDCT was significantly lower than that of ASIR-driven ULDCT and SCT (p = 0.01 and 0.00). Adaptive statistical iterative reconstruction-driven ULDCT delivering a radiation dose of only 0.17 mSv offers acceptable sensitivity in nodule detection compared with SCT and has better performance than FBP-driven ULDCT.

  10. Adaptive Statistical Iterative Reconstruction-Applied Ultra-Low-Dose CT with Radiography-Comparable Radiation Dose: Usefulness for Lung Nodule Detection.

    Science.gov (United States)

    Yoon, Hyun Jung; Chung, Myung Jin; Hwang, Hye Sun; Moon, Jung Won; Lee, Kyung Soo

    2015-01-01

    To assess the performance of adaptive statistical iterative reconstruction (ASIR)-applied ultra-low-dose CT (ULDCT) in detecting small lung nodules. Thirty patients underwent both ULDCT and standard dose CT (SCT). After determining the reference standard nodules, five observers, blinded to the reference standard reading results, independently evaluated SCT and both subsets of ASIR- and filtered back projection (FBP)-driven ULDCT images. Data assessed by observers were compared statistically. Converted effective doses in SCT and ULDCT were 2.81 ± 0.92 and 0.17 ± 0.02 mSv, respectively. A total of 114 lung nodules were detected on SCT as a standard reference. There was no statistically significant difference in sensitivity between ASIR-driven ULDCT and SCT for three out of the five observers (p = 0.678, 0.735, ASIR-driven ULDCT in three out of the five observers (p ASIR-driven ULDCT, and SCT were 0.682, 0.772, and 0.821, respectively, and there were no significant differences in FOM values between ASIR-driven ULDCT and SCT (p = 0.11), but the FOM value of FBP-driven ULDCT was significantly lower than that of ASIR-driven ULDCT and SCT (p = 0.01 and 0.00). Adaptive statistical iterative reconstruction-driven ULDCT delivering a radiation dose of only 0.17 mSv offers acceptable sensitivity in nodule detection compared with SCT and has better performance than FBP-driven ULDCT.

  11. Clinical value of a one-stop-shop low-dose lung screening combined with 18F-FDG PET/CT for the detection of metastatic lung nodules from colorectal cancer

    International Nuclear Information System (INIS)

    Han, Yeon Hee; Lim, Seok Tae; Jeong, Hwan Jeong; Sohn, Myung Hee

    2016-01-01

    The aim of this study was to evaluate the clinical usefulness of additional low-dose high-resolution lung computed tomography (LD-HRCT) combined with 18F-fluoro-2-deoxyglucose positron emission tomography with CT (18F-FDG PET/CT) compared with conventional lung setting image of 18F-FDG PET/CT for the detection of metastatic lung nodules from colorectal cancer. From January 2011 to September 2011, 649 patients with colorectal cancer underwent additional LD-HRCT at maximum inspiration combined with 18F-FDG PET/CT. Forty-five patients were finally diagnosed to have lung metastasis based on histopathologic study or clinical follow-up. Twenty-five of the 45 patients had ≤5 metastatic lung nodules and the other 20 patients had  >5 metastatic nodules. One hundred and twenty nodules in the 25 patients with ≤5 nodules were evaluated by conventional lung setting image of 18F-FDG PET/CT and by additional LD-HRCT respectively. Sensitivities, specificities, diagnostic accuracies, positive predictive values (PPVs), and negative predictive values (NPVs) of conventional lung setting image of 18F-FDG PET/CT and additional LD-HRCT were calculated using standard formulae. The McNemar test and receiver-operating characteristic (ROC) analysis were performed. Of the 120 nodules in the 25 patients with ≤5 metastatic lung nodules, 66 nodules were diagnosed as metastatic. Eleven of the 66 nodules were confirmed histopathologically and the others were diagnosed by clinical follow-up. Conventional lung setting image of 18F-FDG PET/CT detected 40 of the 66 nodules and additional LD-HRCT detected 55 nodules. All 15 nodules missed by conventional lung setting imaging but detected by additional LD-HRCT were <1 cm in size. The sensitivity, specificity, and diagnostic accuracy of the modalities were 60.6 %, 85.2 %, and 71.1 % for conventional lung setting image and 83.3 %, 88.9 %, and 85.8 % for additional LD-HRCT. By ROC analysis, the area under the ROC curve (AUC) of conventional

  12. Clinical value of a one-stop-shop low-dose lung screening combined with {sup 18}F-FDG PET/CT for the detection of metastatic lung nodules from colorectal cancer

    Energy Technology Data Exchange (ETDEWEB)

    Han, Yeon Hee; Lim, Seok Tae; Jeong, Hwan Jeong; Sohn, Myung Hee [Dept. of Nuclear Medicine, Research Institute of Clinical Medicine, Chonbuk National University-Biomedical Research Institute, Chonbuk National University Hospital, Cyclotron Research Center, Molecular Imaging and Therapeutic Medicine Research Center, Chonbuk National University Medical School and Hospital, Jeonju (Korea, Republic of)

    2016-06-15

    The aim of this study was to evaluate the clinical usefulness of additional low-dose high-resolution lung computed tomography (LD-HRCT) combined with 18F-fluoro-2-deoxyglucose positron emission tomography with CT (18F-FDG PET/CT) compared with conventional lung setting image of 18F-FDG PET/CT for the detection of metastatic lung nodules from colorectal cancer. From January 2011 to September 2011, 649 patients with colorectal cancer underwent additional LD-HRCT at maximum inspiration combined with 18F-FDG PET/CT. Forty-five patients were finally diagnosed to have lung metastasis based on histopathologic study or clinical follow-up. Twenty-five of the 45 patients had ≤5 metastatic lung nodules and the other 20 patients had  >5 metastatic nodules. One hundred and twenty nodules in the 25 patients with ≤5 nodules were evaluated by conventional lung setting image of 18F-FDG PET/CT and by additional LD-HRCT respectively. Sensitivities, specificities, diagnostic accuracies, positive predictive values (PPVs), and negative predictive values (NPVs) of conventional lung setting image of 18F-FDG PET/CT and additional LD-HRCT were calculated using standard formulae. The McNemar test and receiver-operating characteristic (ROC) analysis were performed. Of the 120 nodules in the 25 patients with ≤5 metastatic lung nodules, 66 nodules were diagnosed as metastatic. Eleven of the 66 nodules were confirmed histopathologically and the others were diagnosed by clinical follow-up. Conventional lung setting image of 18F-FDG PET/CT detected 40 of the 66 nodules and additional LD-HRCT detected 55 nodules. All 15 nodules missed by conventional lung setting imaging but detected by additional LD-HRCT were <1 cm in size. The sensitivity, specificity, and diagnostic accuracy of the modalities were 60.6 %, 85.2 %, and 71.1 % for conventional lung setting image and 83.3 %, 88.9 %, and 85.8 % for additional LD-HRCT. By ROC analysis, the area under the ROC curve (AUC) of conventional

  13. The Lung Image Database Consortium (LIDC) and Image Database Resource Initiative (IDRI): A Completed Reference Database of Lung Nodules on CT Scans

    Energy Technology Data Exchange (ETDEWEB)

    NONE

    2011-02-15

    Purpose: The development of computer-aided diagnostic (CAD) methods for lung nodule detection, classification, and quantitative assessment can be facilitated through a well-characterized repository of computed tomography (CT) scans. The Lung Image Database Consortium (LIDC) and Image Database Resource Initiative (IDRI) completed such a database, establishing a publicly available reference for the medical imaging research community. Initiated by the National Cancer Institute (NCI), further advanced by the Foundation for the National Institutes of Health (FNIH), and accompanied by the Food and Drug Administration (FDA) through active participation, this public-private partnership demonstrates the success of a consortium founded on a consensus-based process. Methods: Seven academic centers and eight medical imaging companies collaborated to identify, address, and resolve challenging organizational, technical, and clinical issues to provide a solid foundation for a robust database. The LIDC/IDRI Database contains 1018 cases, each of which includes images from a clinical thoracic CT scan and an associated XML file that records the results of a two-phase image annotation process performed by four experienced thoracic radiologists. In the initial blinded-read phase, each radiologist independently reviewed each CT scan and marked lesions belonging to one of three categories (''nodule{>=}3 mm,''''nodule<3 mm,'' and ''non-nodule{>=}3 mm''). In the subsequent unblinded-read phase, each radiologist independently reviewed their own marks along with the anonymized marks of the three other radiologists to render a final opinion. The goal of this process was to identify as completely as possible all lung nodules in each CT scan without requiring forced consensus. Results: The Database contains 7371 lesions marked ''nodule'' by at least one radiologist. 2669 of these lesions were marked ''nodule

  14. Computer-assisted solid lung nodule 3D volumetry on CT : influence of scan mode and iterative reconstruction: a CT phantom study

    NARCIS (Netherlands)

    Coenen, Adriaan; Honda, Osamu; van der Jagt, Eric J.; Tomiyama, Noriyuki

    2013-01-01

    To evaluate the effect of high-resolution scan mode and iterative reconstruction on lung nodule 3D volumetry. Solid nodules with various sizes (5, 8, 10 and 12 mm) were placed inside a chest phantom. CT images were obtained with various tube currents, scan modes (conventional mode, high-resolution

  15. Usefulness of computerized method for lung nodule detection on digital chest radiographs using similar subtraction images from different patients

    International Nuclear Information System (INIS)

    Aoki, Takatoshi; Oda, Nobuhiro; Yamashita, Yoshiko; Yamamoto, Keiji; Korogi, Yukunori

    2012-01-01

    Purpose: The purpose of this study is to evaluate the usefulness of a novel computerized method to select automatically the similar chest radiograph for image subtraction in the patients who have no previous chest radiographs and to assist the radiologists’ interpretation by presenting the “similar subtraction image” from different patients. Materials and methods: Institutional review board approval was obtained, and the requirement for informed patient consent was waived. A large database of approximately 15,000 normal chest radiographs was used for searching similar images of different patients. One hundred images of candidates were selected according to two clinical parameters and similarity of the lung field in the target image. We used the correlation value of chest region in the 100 images for searching the most similar image. The similar subtraction images were obtained by subtracting the similar image selected from the target image. Thirty cases with lung nodules and 30 cases without lung nodules were used for an observer performance test. Four attending radiologists and four radiology residents participated in this observer performance test. Results: The AUC for all radiologists increased significantly from 0.925 to 0.974 with the CAD (P = .004). When the computer output images were available, the average AUC for the residents was more improved (0.960 vs. 0.890) than for the attending radiologists (0.987 vs. 0.960). Conclusion: The novel computerized method for lung nodule detection using similar subtraction images from different patients would be useful to detect lung nodules on digital chest radiographs, especially for less experienced readers.

  16. Clinical Value of a One-Stop-Shop Low-Dose Lung Screening Combined with (18)F-FDG PET/CT for the Detection of Metastatic Lung Nodules from Colorectal Cancer.

    Science.gov (United States)

    Han, Yeon-Hee; Lim, Seok Tae; Jeong, Hwan-Jeong; Sohn, Myung-Hee

    2016-06-01

    The aim of this study was to evaluate the clinical usefulness of additional low-dose high-resolution lung computed tomography (LD-HRCT) combined with (18)F-fluoro-2-deoxyglucose positron emission tomography with CT ((18)F-FDG PET/CT) compared with conventional lung setting image of (18)F-FDG PET/CT for the detection of metastatic lung nodules from colorectal cancer. From January 2011 to September 2011, 649 patients with colorectal cancer underwent additional LD-HRCT at maximum inspiration combined with (18)F-FDG PET/CT. Forty-five patients were finally diagnosed to have lung metastasis based on histopathologic study or clinical follow-up. Twenty-five of the 45 patients had ≤5 metastatic lung nodules and the other 20 patients had >5 metastatic nodules. One hundred and twenty nodules in the 25 patients with ≤5 nodules were evaluated by conventional lung setting image of (18)F-FDG PET/CT and by additional LD-HRCT respectively. Sensitivities, specificities, diagnostic accuracies, positive predictive values (PPVs), and negative predictive values (NPVs) of conventional lung setting image of (18)F-FDG PET/CT and additional LD-HRCT were calculated using standard formulae. The McNemar test and receiver-operating characteristic (ROC) analysis were performed. Of the 120 nodules in the 25 patients with ≤5 metastatic lung nodules, 66 nodules were diagnosed as metastatic. Eleven of the 66 nodules were confirmed histopathologically and the others were diagnosed by clinical follow-up. Conventional lung setting image of (18)F-FDG PET/CT detected 40 of the 66 nodules and additional LD-HRCT detected 55 nodules. All 15 nodules missed by conventional lung setting imaging but detected by additional LD-HRCT were LD-HRCT. By ROC analysis, the area under the ROC curve (AUC) of conventional lung setting image and additional LD-HRCT were 0.712 and 0.827 respectively. Additional LD-HRCT with maximum inspiration was superior to conventional lung setting image of (18)F-FDG PET

  17. Computer-assisted lung nodule volumetry from multi-detector row CT: Influence of image reconstruction parameters

    International Nuclear Information System (INIS)

    Honda, Osamu; Sumikawa, Hiromitsu; Johkoh, Takeshi; Tomiyama, Noriyuki; Mihara, Naoki; Inoue, Atsuo; Tsubamoto, Mitsuko; Natsag, Javzandulam; Hamada, Seiki; Nakamura, Hironobu

    2007-01-01

    Purpose: To investigate differences in volumetric measurement of pulmonary nodules caused by changing the reconstruction parameters for multi-detector row CT. Materials and methods: Thirty-nine pulmonary nodules less than 2 cm in diameter were examined by multi-slice CT. All nodules were solid, and located in the peripheral part of the lungs. The resultant 48 parameters images were reconstructed by changing slice thickness (1.25, 2.5, 3.75, or 5 mm), field of view (FOV: 10, 20, or 30 cm), algorithm (high-spatial frequency algorithm or low-spatial frequency algorithm) and reconstruction interval (reconstruction with 50% overlapping of the reconstructed slices or non-overlapping reconstruction). Volumetric measurements were calculated using commercially available software. The differences between nodule volumes were analyzed by the Kruskal-Wallis test and the Wilcoxon Signed-Ranks test. Results: The diameter of the nodules was 8.7 ± 2.7 mm on average, ranging from 4.3 to 16.4 mm. Pulmonary nodule volume did not change significantly with changes in slice thickness or FOV (p > 0.05), but was significantly larger with the high-spatial frequency algorithm than the low-spatial frequency algorithm (p < 0.05), except for one reconstruction parameter. The volumes determined by non-overlapping reconstruction were significantly larger than those of overlapping reconstruction (p < 0.05), except for a 1.25 mm thickness with 10 cm FOV with the high-spatial frequency algorithm, and 5 mm thickness. The maximum difference in measured volume was 16% on average between the 1.25 mm slice thickness/10 cm FOV/high-spatial frequency algorithm parameters and overlapping reconstruction. Conclusion: Volumetric measurements of pulmonary nodules differ with changes in the reconstruction parameters, with a tendency toward larger volumes in high-spatial frequency algorithm and non-overlapping reconstruction compared to the low-spatial frequency algorithm and overlapping reconstruction

  18. Automated detection of lung nodules in multidetector CT: influence of different reconstruction protocols on performance of a software prototype

    International Nuclear Information System (INIS)

    Gurung, J.; Maataoui, A.; Khan, M.; Wetter, A.; Harth, M.; Jacobi, V.; Vogl, T.J.

    2006-01-01

    Purpose: To evaluate the accuracy of software for computer-aided detection (CAD) of lung nodules using different reconstruction slice thickness protocols in multidetector CT. Materials and Methods: Raw image data sets for 15 patients who had undergone 16-row multidetector CT (MDCT) for known pulmonary nodules were reconstructed at a reconstruction thickness of 5.0, 2.0 and 1.0 mm with a reconstruction increment of 1.5, 1.0 and 0.5 mm, respectively. The ''Nodule Enhanced Viewing'' (NEV) tool of LungCare for computer-aided detection of lung nodules was applied to the reconstructed images. The reconstructed images were also blinded and then evaluated by 2 radiologists (A and B). Data from the evaluating radiologists and CAD was then compared to an independent reference standard established using the consensus of 2 independent experienced chest radiologists. The eligible nodules were grouped according to their size (diameter >10, 5 - 10, <5 mm) for assessment. Statistical analysis was performed using the receiver operating characteristic (ROC) curve analysis, t-test and two-rater Cohen's Kappa co-efficient. Results: A total of 103 nodules were included in the reference standard by the consensus panel. The performance of CAD was marginally lower than that of readers at a 5.0-mm reconstruction thickness (AUC = 0.522, 0.517 and 0.497 for A, B and CAD, respectively). In the case of 2.0-mm reconstruction slices, the performance of CAD was better than that of the readers (AUC = 0.524, 0.524 and 0.614 for A, B and CAD, respectively). CAD was found to be significantly superior to radiologists in the case of 1.0-mm reconstruction slices (AUC = 0.537, 0.531 and 0.675 for A, B and CAD, respectively). The sensitivity at a reconstruction thickness of 1.0 mm was determined to be 66.99%, 68.93% and 80.58% for A, B and CAD, respectively. The time required for detection was shortest for CAD at reconstruction slices of 1.0 mm (mean t = 4 min). The performance of radiologists was greatly

  19. The additional value of the lateral chest radiograph for the detection of small pulmonary nodules-a ROC analysis.

    Science.gov (United States)

    Kluthke, Robin Alexander; Kickuth, Ralph; Bansmann, Paul Martin; Tüshaus, Carolin; Adams, Stephan; Liermann, Dieter; Kirchner, Johannes

    2016-11-01

    For the past 30 years, many authors have described different advantages of the use of the additional lateral chest radiograph. However, some radiologic departments gave up performing the lateral view recently. A potential reason for this might be a lack of evidence for any diagnostic benefit of the additional lateral view of the thorax in recent studies. The objective of this study was to evaluate the diagnostic benefit of the additional lateral view for the detection of small pulmonary nodules compared with CT examinations as a gold standard. The patient population consisted of 45 patients with SPN and 45 patients without SPN. Four radiologists with varying experience in the assessment of thoracic imaging first examined the sole posteroanterior (PA) projection. After a few days, they were instructed to examine the PA and the additional lateral view. A receiver-operating characteristic analysis was accomplished to compare the documented results. The mean Az value of the sole PA view was 0.75 and 0.77 by the combination of PA and additional lateral view. So, there was no significant difference between the detectable Az values (Δ = 0.02; p = 0.384). With a cut-off value of >3, the additional view even reduced the sensitivity by averaging to 5.6%. The decrease of sensitivity by using the additional view was most detectable within the group of more experienced radiologists. The additional lateral view of the chest provides no diagnostic benefit in the detection of small pulmonary nodules in comparison with the sole PA projection. Nevertheless, the results of the present study must not be understood as a general evaluation of the benefits of the lateral radiograph per se, because we did not examine other relevant issues (i.e. cardiac failure, lung parenchyma diseases or abnormalities in hilar anatomy). Advances in knowledge: Our study demonstrates a lack of evidence for any diagnostic benefit of the additional lateral view of the thorax in detecting SPN.

  20. Current therapy of small cell lung cancer

    DEFF Research Database (Denmark)

    Sorensen, M; Lassen, U; Hansen, H H

    1998-01-01

    This article reviews the most important recent clinical trials on the treatment of small cell lung cancer (SCLC). Two randomized studies addressing the timing of thoracic radiotherapy in limited stage SCLC are discussed. In the smaller of the two studies (n = 103), a survival benefit was associated...

  1. Pulmonary Rehabilitation in Improving Lung Function in Patients With Locally Advanced Non-Small Cell Lung Cancer Undergoing Chemoradiation

    Science.gov (United States)

    2017-04-12

    Cachexia; Fatigue; Pulmonary Complications; Radiation Toxicity; Recurrent Non-small Cell Lung Cancer; Stage IIIA Non-small Cell Lung Cancer; Stage IIIB Non-small Cell Lung Cancer; Stage IV Non-small Cell Lung Cancer

  2. Automatic Approach for Lung Segmentation with Juxta-Pleural Nodules from Thoracic CT Based on Contour Tracing and Correction

    Directory of Open Access Journals (Sweden)

    Jinke Wang

    2016-01-01

    Full Text Available This paper presents a fully automatic framework for lung segmentation, in which juxta-pleural nodule problem is brought into strong focus. The proposed scheme consists of three phases: skin boundary detection, rough segmentation of lung contour, and pulmonary parenchyma refinement. Firstly, chest skin boundary is extracted through image aligning, morphology operation, and connective region analysis. Secondly, diagonal-based border tracing is implemented for lung contour segmentation, with maximum cost path algorithm used for separating the left and right lungs. Finally, by arc-based border smoothing and concave-based border correction, the refined pulmonary parenchyma is obtained. The proposed scheme is evaluated on 45 volumes of chest scans, with volume difference (VD 11.15±69.63 cm3, volume overlap error (VOE 3.5057±1.3719%, average surface distance (ASD 0.7917±0.2741 mm, root mean square distance (RMSD 1.6957±0.6568 mm, maximum symmetric absolute surface distance (MSD 21.3430±8.1743 mm, and average time-cost 2 seconds per image. The preliminary results on accuracy and complexity prove that our scheme is a promising tool for lung segmentation with juxta-pleural nodules.

  3. Evolutionary image simplification for lung nodule classification with convolutional neural networks.

    Science.gov (United States)

    Lückehe, Daniel; von Voigt, Gabriele

    2018-05-29

    Understanding decisions of deep learning techniques is important. Especially in the medical field, the reasons for a decision in a classification task are as crucial as the pure classification results. In this article, we propose a new approach to compute relevant parts of a medical image. Knowing the relevant parts makes it easier to understand decisions. In our approach, a convolutional neural network is employed to learn structures of images of lung nodules. Then, an evolutionary algorithm is applied to compute a simplified version of an unknown image based on the learned structures by the convolutional neural network. In the simplified version, irrelevant parts are removed from the original image. In the results, we show simplified images which allow the observer to focus on the relevant parts. In these images, more than 50% of the pixels are simplified. The simplified pixels do not change the meaning of the images based on the learned structures by the convolutional neural network. An experimental analysis shows the potential of the approach. Besides the examples of simplified images, we analyze the run time development. Simplified images make it easier to focus on relevant parts and to find reasons for a decision. The combination of an evolutionary algorithm employing a learned convolutional neural network is well suited for the simplification task. From a research perspective, it is interesting which areas of the images are simplified and which parts are taken as relevant.

  4. A approach for differential diagnosis of primary lung cancer and breast cancer relapse presenting as a solitary pulmonary nodule in patients after breast surgery

    International Nuclear Information System (INIS)

    Fujita, Takashi; Iwata, Hiroharu; Yatabe, Yasushi

    2009-01-01

    The differential diagnosis of primary lung cancer from metastatic breast cancer is crucial in patients presenting with a solitary pulmonary nodule after breast surgery. However definitive diagnosis of these nodules is often difficult due to similar radiological and pathological features in primary lung and metastatic breast cancer nodules. We assessed the feasibility of our diagnostic approach for these nodules by morphopathological and immunohistochemical examination (thyroid transcription factor-1 (TTF-1), surfactant pro-protein B (SPPB), estrogen receptor (ER), mammaglobin-1 (MGB1)), and estimated the frequency of primary lung cancer occurrence in 23 breast cancer patients. Biopsy specimens were obtained using CT-guided needle biopsy (NB) and transbronchial lung biopsy (TBLB) in 21 patients (91.3%). Surgical resection was performed for diagnosis and treatment in two patients. Differential diagnosis was obtained by morphopathological methods alone in 17 patients (73.9%, primary lung cancer: 6 cases, metastatic breast cancer: 11 cases) and by immunohistochemical examination in the remaining 6 (26.1%, primary lung cancer: 1 case, metastatic breast cancer: 5 cases). Our results show the clinical feasibility of our approach to the differential diagnosis of breast cancer relapse and primary lung cancer presenting as a solitary nodule in breast cancer patients. (author)

  5. Interobserver-variability of lung nodule volumetry considering different segmentation algorithms and observer training levels

    International Nuclear Information System (INIS)

    Bolte, H.; Jahnke, T.; Schaefer, F.K.W.; Wenke, R.; Hoffmann, B.; Freitag-Wolf, S.; Dicken, V.; Kuhnigk, J.M.; Lohmann, J.; Voss, S.; Knoess, N.

    2007-01-01

    Objective: The aim of this study was to investigate the interobserver variability of CT based diameter and volumetric measurements of artificial pulmonary nodules. A special interest was the consideration of different measurement methods, observer experience and training levels. Materials and methods: For this purpose 46 artificial small solid nodules were examined in a dedicated ex-vivo chest phantom with multislice-spiral CT (20 mAs, 120 kV, collimation 16 mm x 0.75 mm, table feed 15 mm, reconstructed slice thickness 1 mm, reconstruction increment 0.7 mm, intermediate reconstruction kernel). Two observer groups of different radiologic experience (0 and more than 5 years of training, 3 observers each) analysed all lesions with digital callipers and 2 volumetry software packages (click-point depending and robust volumetry) in a semi-automatic and manually corrected mode. For data analysis the variation coefficient (VC) was calculated in per cent for each group and a Wilcoxon test was used for analytic statistics. Results: Click-point robust volumetry showed with a VC of <0.01% in both groups the smallest interobserver variability. Between experienced and un-experienced observers interobserver variability was significantly different for diameter measurements (p = 0.023) but not for semi-automatic and manual corrected volumetry. A significant training effect was revealed for diameter measurements (p = 0.003) and semi-automatic measurements of click-point depending volumetry (p = 0.007) in the un-experienced observer group. Conclusions: Compared to diameter measurements volumetry achieves a significantly smaller interobserver variance and advanced volumetry algorithms are independent of observer experience

  6. CT and histopathologic characteristics of lung adenocarcinoma with pure ground-glass nodules 10 mm or less in diameter

    Energy Technology Data Exchange (ETDEWEB)

    Wu, Fang [Chinese PLA General Hospital, Department of Radiology, Beijing (China); Capital Medical University, Department of Radiology, Xuanwu Hospital, Beijing (China); Tian, Shu-ping [Navy General Hospital, Department of Radiology, Beijing (China); Jin, Xin; Jing, Rui; Yang, Yue-qing; Jin, Mei; Zhao, Shao-hong [Chinese PLA General Hospital, Department of Radiology, Beijing (China)

    2017-10-15

    To evaluate CT and histopathologic features of lung adenocarcinoma with pure ground-glass nodule (pGGN) ≤10 mm in diameter. CT appearances of 148 patients (150 lesions) who underwent curative resection of lung adenocarcinoma with pGGN ≤10 mm (25 atypical adenomatous hyperplasias, 42 adenocarcinoma in situs, 38 minimally invasive adenocarcinomas, and 45 invasive pulmonary adenocarcinomas) were analyzed for lesion size, density, bubble-like sign, air bronchogram, vessel changes, margin, and tumour-lung interface. CT characteristics were compared among different histopathologic subtypes. Univariate and multivariate analysis were used to assess the relationship between CT characteristics of pGGN and lesion invasiveness, respectively. There were statistically significant differences among histopathologic subtypes in lesion size, vessel changes, and tumour-lung interface (P<0.05). Univariate analysis revealed significant differences of vessel changes, margin and tumour-lung interface between preinvasive and invasive lesions (P<0.05). Logistic regression analysis showed that the vessel changes, unsmooth margin and clear tumour-lung interface were significant predictive factors for lesion invasiveness, with odds ratios (95% CI) of 2.57 (1.17-5.62), 1.83 (1.25-2.68) and 4.25 (1.78-10.14), respectively. Invasive lesions are found in 55.3% of subcentimeter pGGNs in our cohort. Vessel changes, unsmooth margin, and clear lung-tumour interface may indicate the invasiveness of lung adenocarcinoma with subcentimeter pGGN. (orig.)

  7. Computerized detection of lung nodules by means of "virtual dual-energy" radiography.

    Science.gov (United States)

    Chen, Sheng; Suzuki, Kenji

    2013-02-01

    Major challenges in current computer-aided detection (CADe) schemes for nodule detection in chest radiographs (CXRs) are to detect nodules that overlap with ribs and/or clavicles and to reduce the frequent false positives (FPs) caused by ribs. Detection of such nodules by a CADe scheme is very important, because radiologists are likely to miss such subtle nodules. Our purpose in this study was to develop a CADe scheme with improved sensitivity and specificity by use of "virtual dual-energy" (VDE) CXRs where ribs and clavicles are suppressed with massive-training artificial neural networks (MTANNs). To reduce rib-induced FPs and detect nodules overlapping with ribs, we incorporated the VDE technology in our CADe scheme. The VDE technology suppressed rib and clavicle opacities in CXRs while maintaining soft-tissue opacity by use of the MTANN technique that had been trained with real dual-energy imaging. Our scheme detected nodule candidates on VDE images by use of a morphologic filtering technique. Sixty morphologic and gray-level-based features were extracted from each candidate from both original and VDE CXRs. A nonlinear support vector classifier was employed for classification of the nodule candidates. A publicly available database containing 140 nodules in 140 CXRs and 93 normal CXRs was used for testing our CADe scheme. All nodules were confirmed by computed tomography examinations, and the average size of the nodules was 17.8 mm. Thirty percent (42/140) of the nodules were rated "extremely subtle" or "very subtle" by a radiologist. The original scheme without VDE technology achieved a sensitivity of 78.6% (110/140) with 5 (1165/233) FPs per image. By use of the VDE technology, more nodules overlapping with ribs or clavicles were detected and the sensitivity was improved substantially to 85.0% (119/140) at the same FP rate in a leave-one-out cross-validation test, whereas the FP rate was reduced to 2.5 (583/233) per image at the same sensitivity level as the

  8. Computerized Detection of Lung Nodules by Means of “Virtual Dual-Energy” Radiography

    Science.gov (United States)

    Chen, Sheng; Suzuki, Kenji

    2014-01-01

    Major challenges in current computer-aided detection (CADe) schemes for nodule detection in chest radiographs (CXRs) are to detect nodules that overlap with ribs and/or clavicles and to reduce the frequent false positives (FPs) caused by ribs. Detection of such nodules by a CADe scheme is very important, because radiologists are likely to miss such subtle nodules. Our purpose in this study was to develop a CADe scheme with improved sensitivity and specificity by use of “virtual dual-energy” (VDE) CXRs where ribs and clavicles are suppressed with massive-training artificial neural networks (MTANNs). To reduce rib-induced FPs and detect nodules overlapping with ribs, we incorporated the VDE technology in our CADe scheme. The VDE technology suppressed rib and clavicle opacities in CXRs while maintaining soft-tissue opacity by use of the MTANN technique that had been trained with real dual-energy imaging. Our scheme detected nodule candidates on VDE images by use of a morphologic filtering technique. Sixty morphologic and gray-level-based features were extracted from each candidate from both original and VDE CXRs. A nonlinear support vector classifier was employed for classification of the nodule candidates. A publicly available database containing 140 nodules in 140 CXRs and 93 normal CXRs was used for testing our CADe scheme. All nodules were confirmed by computed tomography examinations, and the average size of the nodules was 17.8 mm. Thirty percent (42/140) of the nodules were rated “extremely subtle” or “very subtle” by a radiologist. The original scheme without VDE technology achieved a sensitivity of 78.6% (110/140) with 5 (1165/233) FPs per image. By use of the VDE technology, more nodules overlapping with ribs or clavicles were detected and the sensitivity was improved substantially to 85.0% (119/140) at the same FP rate in a leave-one-out cross-validation test, whereas the FP rate was reduced to 2.5 (583/233) per image at the same sensitivity

  9. Data-driven decision support for radiologists: re-using the National Lung Screening Trial dataset for pulmonary nodule management.

    Science.gov (United States)

    Morrison, James J; Hostetter, Jason; Wang, Kenneth; Siegel, Eliot L

    2015-02-01

    Real-time mining of large research trial datasets enables development of case-based clinical decision support tools. Several applicable research datasets exist including the National Lung Screening Trial (NLST), a dataset unparalleled in size and scope for studying population-based lung cancer screening. Using these data, a clinical decision support tool was developed which matches patient demographics and lung nodule characteristics to a cohort of similar patients. The NLST dataset was converted into Structured Query Language (SQL) tables hosted on a web server, and a web-based JavaScript application was developed which performs real-time queries. JavaScript is used for both the server-side and client-side language, allowing for rapid development of a robust client interface and server-side data layer. Real-time data mining of user-specified patient cohorts achieved a rapid return of cohort cancer statistics and lung nodule distribution information. This system demonstrates the potential of individualized real-time data mining using large high-quality clinical trial datasets to drive evidence-based clinical decision-making.

  10. Massive training artificial neural network (MTANN) for reduction of false positives in computerized detection of lung nodules in low-dose computed tomography

    International Nuclear Information System (INIS)

    Suzuki, Kenji; Armato, Samuel G. III; Li, Feng; Sone, Shusuke; Doi, Kunio

    2003-01-01

    In this study, we investigated a pattern-recognition technique based on an artificial neural network (ANN), which is called a massive training artificial neural network (MTANN), for reduction of false positives in computerized detection of lung nodules in low-dose computed tomography (CT) images. The MTANN consists of a modified multilayer ANN, which is capable of operating on image data directly. The MTANN is trained by use of a large number of subregions extracted from input images together with the teacher images containing the distribution for the 'likelihood of being a nodule'. The output image is obtained by scanning an input image with the MTANN. The distinction between a nodule and a non-nodule is made by use of a score which is defined from the output image of the trained MTANN. In order to eliminate various types of non-nodules, we extended the capability of a single MTANN, and developed a multiple MTANN (Multi-MTANN). The Multi-MTANN consists of plural MTANNs that are arranged in parallel. Each MTANN is trained by using the same nodules, but with a different type of non-nodule. Each MTANN acts as an expert for a specific type of non-nodule, e.g., five different MTANNs were trained to distinguish nodules from various-sized vessels; four other MTANNs were applied to eliminate some other opacities. The outputs of the MTANNs were combined by using the logical AND operation such that each of the trained MTANNs eliminated none of the nodules, but removed the specific type of non-nodule with which the MTANN was trained, and thus removed various types of non-nodules. The Multi-MTANN consisting of nine MTANNs was trained with 10 typical nodules and 10 non-nodules representing each of nine different non-nodule types (90 training non-nodules overall) in a training set. The trained Multi-MTANN was applied to the reduction of false positives reported by our current computerized scheme for lung nodule detection based on a database of 63 low-dose CT scans (1765

  11. Pulmonary cavitary mass containing a mural nodule: differential diagnosis between intracavitary aspergilloma and cavitating lung cancer on contrast-enhanced computed tomography

    International Nuclear Information System (INIS)

    Park, Y.; Kim, T.S.; Yi, C.A.; Cho, E.Y.; Kim, H.; Choi, Y.S.

    2007-01-01

    Aim: The objective of this study was to identify whether there were any significant differences in the computed tomography (CT) findings of an intracavitary aspergilloma and a cavitating lung cancer containing a mural nodule. Materials and methods: The CT and histopathological findings of 12 patients (male:female ratio 3:9; aged 51-76 years) with cavitating lung cancer containing a mural nodule and 26 patients (male:female ratio 14:12; aged 29-72 years) with intracavitary aspergilloma were retrospectively reviewed. Results: The mural nodules within cavitating lung cancer were more enhanced (p < 0.001) and showed a nondependent location more frequently (p = 0.012) than those of intracavitary aspergillomas. The cavitary walls were thicker in cavitating lung cancer (mean 5.8 mm thick) than those in intracavitary aspergillomas (mean 2.6 mm thick; p = 0.035). Adjacent bronchiectasis and volume decrease of the involved lobe were observed more frequently in intracavitary aspergillomas than in cavitating lung cancers (p < 0.001 and p = 0.008, respectively). Conclusion: Whether a mural nodule within a cavitary lesion is contrast-enhanced or not is one of the most important features in making a differential diagnosis between an intracavitary aspergilloma and a cavitating lung cancer. Assessment of dependent location of a mural nodule within the cavity and wall thickness of the cavity itself can also be helpful for differentiation

  12. Pulmonary cavitary mass containing a mural nodule: differential diagnosis between intracavitary aspergilloma and cavitating lung cancer on contrast-enhanced computed tomography

    Energy Technology Data Exchange (ETDEWEB)

    Park, Y. [Department of Radiology and Center for Imaging Science, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul 135-710 (Korea, Republic of); Kim, T.S. [Department of Radiology and Center for Imaging Science, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul 135-710 (Korea, Republic of)]. E-mail: tskim.kim@samsung.com; Yi, C.A. [Department of Radiology and Center for Imaging Science, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul 135-710 (Korea, Republic of); Cho, E.Y. [Department of Pathology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul 135-710 (Korea, Republic of); Kim, H. [Division of Pulmonary and Critical Care Medicine, Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul 135-710 (Korea, Republic of); Choi, Y.S. [Department of Thoracic and Cardiovascular Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul 135-710 (Korea, Republic of)

    2007-03-15

    Aim: The objective of this study was to identify whether there were any significant differences in the computed tomography (CT) findings of an intracavitary aspergilloma and a cavitating lung cancer containing a mural nodule. Materials and methods: The CT and histopathological findings of 12 patients (male:female ratio 3:9; aged 51-76 years) with cavitating lung cancer containing a mural nodule and 26 patients (male:female ratio 14:12; aged 29-72 years) with intracavitary aspergilloma were retrospectively reviewed. Results: The mural nodules within cavitating lung cancer were more enhanced (p < 0.001) and showed a nondependent location more frequently (p = 0.012) than those of intracavitary aspergillomas. The cavitary walls were thicker in cavitating lung cancer (mean 5.8 mm thick) than those in intracavitary aspergillomas (mean 2.6 mm thick; p = 0.035). Adjacent bronchiectasis and volume decrease of the involved lobe were observed more frequently in intracavitary aspergillomas than in cavitating lung cancers (p < 0.001 and p = 0.008, respectively). Conclusion: Whether a mural nodule within a cavitary lesion is contrast-enhanced or not is one of the most important features in making a differential diagnosis between an intracavitary aspergilloma and a cavitating lung cancer. Assessment of dependent location of a mural nodule within the cavity and wall thickness of the cavity itself can also be helpful for differentiation.

  13. Lung cancer risk and cancer-specific mortality in subjects undergoing routine imaging test when stratified with and without identified lung nodule on imaging study

    Energy Technology Data Exchange (ETDEWEB)

    Gomez-Saez, Noemi [Miguel Hernandez University, Public Health, History of Science and Ginecology Department, Alicante (Spain); Hernandez-Aguado, Ildefonso; Pastor Valero, Maria; Parker, Lucy Anne; Lumbreras, Blanca [Miguel Hernandez University, Public Health, History of Science and Ginecology Department, Alicante (Spain); CIBER en Epidemiologia y Salud Publica, Madrid (Spain); Vilar, Jose; Domingo, Maria Luisa [Peset Hospital, Radiodiagnostic Department, Valencia (Spain); Gonzalez-Alvarez, Isabel; Lorente, Maria Fermina [San Juan Hospital, Radiodiagnostic Department, San Juan de Alicante (Spain)

    2015-12-15

    To assess the risk of lung cancer and specific mortality rate in patients with and without solitary pulmonary nodules (SPN) on chest radiograph and CT. This prospective study included 16,078 patients ≥35 years old (893 of them had an SPN detected with either chest radiograph or CT) and 15,185 without SPN. Patients were followed up for 18 months or until being diagnosed with lung cancer. Risk and mortality lung cancer were calculated in both groups with Poisson regression. In patients with SPN, incidence of lung cancer was 8.3 % (95 % CI 6.0-11.2) on radiograph and 12.4 % (95 % CI 9.3-15.9) on CT. A chronic obstructive pulmonary disease in patients with radiographs (odds ratio 2.62; 95 % CI 1.03, 6.67) and smoking habit (odds ratio 20.63; 95 % CI 3.84, 110.77) in patients with CT were associated with a higher probability of lung cancer. Large nodule size and spiculated edge were associated with lung cancer on both CT and radiograph. Lung cancer-specific mortality was lower in patients with SPN than in those without SPN (1.73/1000 person-years, 95 % CI 1.08-2.88 vs. 2.15/1000 person-years, 95 % CI 1.25-3.96). The risk of lung cancer for patients with SPN is higher in clinical populations than in screening studies. Moreover, patients with SPN showed lower mortality than those without SPN. (orig.)

  14. Lung cancer risk and cancer-specific mortality in subjects undergoing routine imaging test when stratified with and without identified lung nodule on imaging study

    International Nuclear Information System (INIS)

    Gomez-Saez, Noemi; Hernandez-Aguado, Ildefonso; Pastor Valero, Maria; Parker, Lucy Anne; Lumbreras, Blanca; Vilar, Jose; Domingo, Maria Luisa; Gonzalez-Alvarez, Isabel; Lorente, Maria Fermina

    2015-01-01

    To assess the risk of lung cancer and specific mortality rate in patients with and without solitary pulmonary nodules (SPN) on chest radiograph and CT. This prospective study included 16,078 patients ≥35 years old (893 of them had an SPN detected with either chest radiograph or CT) and 15,185 without SPN. Patients were followed up for 18 months or until being diagnosed with lung cancer. Risk and mortality lung cancer were calculated in both groups with Poisson regression. In patients with SPN, incidence of lung cancer was 8.3 % (95 % CI 6.0-11.2) on radiograph and 12.4 % (95 % CI 9.3-15.9) on CT. A chronic obstructive pulmonary disease in patients with radiographs (odds ratio 2.62; 95 % CI 1.03, 6.67) and smoking habit (odds ratio 20.63; 95 % CI 3.84, 110.77) in patients with CT were associated with a higher probability of lung cancer. Large nodule size and spiculated edge were associated with lung cancer on both CT and radiograph. Lung cancer-specific mortality was lower in patients with SPN than in those without SPN (1.73/1000 person-years, 95 % CI 1.08-2.88 vs. 2.15/1000 person-years, 95 % CI 1.25-3.96). The risk of lung cancer for patients with SPN is higher in clinical populations than in screening studies. Moreover, patients with SPN showed lower mortality than those without SPN. (orig.)

  15. Small cell lung cancer: chemo- and radiotherapy

    International Nuclear Information System (INIS)

    Drings, P.

    1992-01-01

    Small-Cell Lung Cancer - Chemo- and Radiotherapy: Small-cell lung cancer (SCLC) should be regarded as a systematic disease for which systematic therapy, i.e. chemotherapy, is considered as the cornerstone of treatment. Combination chemotherapy consisting of 2 or mostly 3 active drugs, given at an adequate dose, should be used. Thoracic radiation therapy promises both survival and local-regional control benefits to patients though its optimal role remains to be definitively established. The results of treatment have reached a plateau with a remission rate of up to 90% in stage 'limited disease' and 60% in stage 'extensive disease'. But considering long-term results diseasefree survival and cure only seem possible in 5-10% of patients with limited disease. (orig.) [de

  16. Differential diagnosis of a solitary pulmonary nodule of the lung on the grounds of selected laboratory tests and radiological examination

    International Nuclear Information System (INIS)

    Szlachcinska, A.; Kozak, J.

    2011-01-01

    Objective: To present in detail the diagnosis of solitary pulmonary nodule and especially evaluation of: clinical data, analysis of radiological images, selected laboratory tests. Material and methods: There were 50 patients - 31 men and 19 women at the mean age 58.7 ± 11.4 years old who underwent surgical treatment because of a solitary pulmonary nodule. Interview, physical examination, computed tomography, bronchoscopy, spirometry, and laboratory tests needed for the operation were performed in all these patients. Additionally LDH, fibrinogen, ESR, and the tumour markers CEA, Ca 15-3, Ca 19-9, NSE, SCC, and Cyfra 21-1 were measured from the blood sample collected during admission. Results: Malignant tumour was diagnosed in 24 patients, benign in 26. There is a significant difference between patients with malignant and nonmalignant tumours in age (54.46 years vs. 63.33 years), size of the tumour in the lung scan of chest CT (1.53 cm vs. 1.91 cm) and location (lower right lobe vs. upper right lobe). There is no significant difference between type of tumour and sex, clinical symptoms and laboratory tests. Conclusions: 1. The risk factors of malignancy in patient with solitary pulmonary nodule are: age ≥ 56.5 years, size of the tumour in the lung scan of chest CT ≥ 1.45 cm, location in upper right lobe. 2. LDH, fibrinogen, ESR, and the tumour markers CEA, Ca 15-3, Ca 19-9, NSE, SCC, and Cyfra 21-1 are not useful in differential diagnosis of solitary pulmonary nodule. (authors)

  17. The Lung Image Database Consortium (LIDC) and Image Database Resource Initiative (IDRI): A Completed Reference Database of Lung Nodules on CT Scans

    International Nuclear Information System (INIS)

    2011-01-01

    Purpose: The development of computer-aided diagnostic (CAD) methods for lung nodule detection, classification, and quantitative assessment can be facilitated through a well-characterized repository of computed tomography (CT) scans. The Lung Image Database Consortium (LIDC) and Image Database Resource Initiative (IDRI) completed such a database, establishing a publicly available reference for the medical imaging research community. Initiated by the National Cancer Institute (NCI), further advanced by the Foundation for the National Institutes of Health (FNIH), and accompanied by the Food and Drug Administration (FDA) through active participation, this public-private partnership demonstrates the success of a consortium founded on a consensus-based process. Methods: Seven academic centers and eight medical imaging companies collaborated to identify, address, and resolve challenging organizational, technical, and clinical issues to provide a solid foundation for a robust database. The LIDC/IDRI Database contains 1018 cases, each of which includes images from a clinical thoracic CT scan and an associated XML file that records the results of a two-phase image annotation process performed by four experienced thoracic radiologists. In the initial blinded-read phase, each radiologist independently reviewed each CT scan and marked lesions belonging to one of three categories (''nodule≥3 mm,''''nodule<3 mm,'' and ''non-nodule≥3 mm''). In the subsequent unblinded-read phase, each radiologist independently reviewed their own marks along with the anonymized marks of the three other radiologists to render a final opinion. The goal of this process was to identify as completely as possible all lung nodules in each CT scan without requiring forced consensus. Results: The Database contains 7371 lesions marked ''nodule'' by at least one radiologist. 2669 of these lesions were marked ''nodule≥3 mm'' by at least one radiologist, of which 928 (34.7%) received such marks from all

  18. CEUS: An essential component in a multimodality approach to small nodules in patients at high-risk for hepatocellular carcinoma

    Energy Technology Data Exchange (ETDEWEB)

    Jang, Hyun-Jung, E-mail: Hyun-Jung.jang@uhn.ca [Department of Medical Imaging, Toronto General Hospital, University of Toronto, 585 University Avenue, Toronto, Ontario M5G 2N2 (Canada); Kim, Tae Kyoung, E-mail: Taekyoung.Kim@uhn.ca [Department of Medical Imaging, Toronto General Hospital, University of Toronto, 585 University Avenue, Toronto, Ontario M5G 2N2 (Canada); Burns, Peter N, E-mail: burns@sri.utoronto.ca [Department of Imaging Research, University of Toronto, Sunnybrook Health Sciences centre, 2075 Bayview Avenue, Toronto ON M4 N 3M5 (Canada); Wilson, Stephanie R, E-mail: Stephanie.wilson@albertahealthservices.ca [Department of Radiology, University of Calgary, Foothills Medical Centre, 1403 29 Street NW, Calgary, AB T2R 1M5 (Canada)

    2015-09-15

    Highlights: • CEUS resolves hypervascular pseudolesions, frequent on CT and MR, from vascular shunts. • US has the advantage of showing a baseline nodule for characterization. • CEUS shows excellent sensitivity to contrast agents, providing superior arterial phase sensitivity. • Real-time CEUS performance shows optimally perfusion patterns of benign tumor nodules. • CEUS performed at surveillance detection of nodules is efficient and effective. - Abstract: Contrast-enhanced ultrasound (CEUS) plays an essential role in the evaluation of small nodules in livers at high-risk for hepatocellular carcinoma (HCC) and offers unique advantages over CT/MRI. These include the sensitive depiction of arterial hypervascularity of HCC, better demonstration of rapid washout for non-HCC malignancy as well as of very late washout of HCC. Visualization of early vascular filling patterns for benign hypervascular lesions is of indisputable value. A frequently uncounted benefit of CEUS includes the value of its performance following nodule detection at ultrasound surveillance, including one-stop exclusion of typical benignancy, preclusion of arterial pseudolesions shown on CT/MR, and the avoidance of miscorrelation of a nodule on surveillance and subsequent diagnostic imaging. Therefore, CEUS can effectively be used in the diagnostic algorithm for new liver nodules detected during HCC surveillance. Despite the fact that CEUS is actively used as a major diagnostic test for HCC in Asia, Europe, and Canada with increasing demands in clinical practice, CEUS is not included in the diagnostic tests for HCC in some major practice guidelines. In this manuscript, we focus on small nodules in patients at high-risk for HCC, and review some of the unique advantages of CEUS that contribute to lesion characterization and subsequent patient management, showing why CEUS should be an essential component of the diagnostic algorithm for HCC.

  19. Whether and under what conditions FDG-PET might be cost-effective in evaluating solitary pulmonary nodules depicted on lung cancer screening in Japan

    International Nuclear Information System (INIS)

    Tsushima, Yoshito; Aoki, Jun; Endo, Keigo

    2003-01-01

    The purpose of this study was to determine whether and under what conditions fluorine-18 fluorodeoxyglucose positron emission tomography (FDG-PET) may be cost-effective in evaluating solitary pulmonary nodules depicted on lung cancer screening in Japan. Three decision models for differentiating lung cancer from benign nodules were compared: CT alone, PET alone, and CT plus PET. The various paths of each strategy were dependent on variables determined from a review of the medical literature. Costs were based on Japanese health insurance. The prevalence of lung cancer among solitary pulmonary nodules detected on lung cancer screening was less than 10%. For this prevalence, the CT-plus-PET model was the cost-effective alternative to the CT-alone model (cost savings were 64,000 yen per patient) and provided greater accuracy (0.90 vs. 0.84). Both of these effects were the result of reducing the number of candidates who undergo unnecessary CT-guided or bronchofiberscopic biopsies or thoracotomy for a benign pulmonary nodule. The CT-plus-PET strategy is accurate and cost-effective for the characterization of solitary pulmonary nodules detected on lung cancer screening in Japan. (author)

  20. MET and Small-Cell Lung Cancer

    Directory of Open Access Journals (Sweden)

    Francesco Gelsomino

    2014-10-01

    Full Text Available Small-cell lung cancer (SCLC is one of the most aggressive lung tumors. The majority of patients with SCLC are diagnosed at an advanced stage. This tumor type is highly sensitive to chemo-radiation treatment, with very high response rates, but invariably relapses. At this time, treatment options are still limited and the prognosis of these patients is poor. A better knowledge of the molecular biology of SCLC allowed us to identify potential druggable targets. Among these, the MET/HGF axis seems to be one of the most aberrant signaling pathways involved in SCLC invasiveness and progression. In this review, we describe briefly all recent literature on the different molecular profiling in SCLC; in particular, we discuss the specific alterations involving c-MET gene and their implications as a potential target in SCLC.

  1. Correlation of emphysema score with perceived malignancy of pulmonary nodules: a multi-observer study using the LIDC-IDRI CT lung database

    Science.gov (United States)

    Wiemker, Rafael; Bülow, Thomas; Blaffert, Thomas; Dharaiya, Ekta

    2009-02-01

    Presence of emphysema is recognized to be one of the single most significant risk factors in risk models for the prediction of lung cancer. Therefore, an automatically computed emphysema score would be a prime candidate as an additional numerical feature for computer aided diagnosis (CADx) for indeterminate pulmonary nodules. We have applied several histogram-based emphysema scores to 460 thoracic CT scans from the IDRI CT lung image database, and analyzed the emphysema scores in conjunction with 3000 nodule malignancy ratings of 1232 pulmonary nodules made by expert observers. Despite the emphysema being a known risk factor, we have not found any impact on the readers' malignancy rating of nodules found in a patient with higher emphysema score. We have also not found any correlation between the number of expert-detected nodules in a patient and his emphysema score, or the relative craniocaudal location of the nodules and their malignancy rating. The inter-observer agreement of the expert ratings was excellent on nodule diameter (as derived from manual delineations), good for calcification, and only modest for malignancy and shape descriptions such as spiculation, lobulation, margin, etc.

  2. Emphysema and soluble CD14 are associated with pulmonary nodules in HIV-infected patients: implications for lung cancer screening.

    Science.gov (United States)

    Triplette, Matthew; Sigel, Keith M; Morris, Alison; Shahrir, Shahida; Wisnivesky, Juan P; Kong, Chung Y; Diaz, Phillip T; Petraglia, Alycia; Crothers, Kristina

    2017-07-31

    Lung cancer screening may benefit HIV-infected (HIV) smokers because of an elevated risk of lung cancer, but may have unique harms because of HIV-specific risk factors for false-positive screens. This study seeks to understand whether inflammatory biomarkers and markers of chronic lung disease are associated with noncalcified nodules at least 4 mm (NCN) in HIV compared with uninfected patients. This is a cohort study of Examinations of HIV-Associated Lung Emphysema (EXHALE), including 158 HIV and 133 HIV-uninfected participants. Participants underwent a laboratory assessment [including measurement of D-dimer, interleukin 6, and soluble CD14 (sCD14)], chest computed tomography (CT), and pulmonary function testing. We created multivariable logistic regression models to determine predictors of NCN in the participants stratified by HIV status, with attention to semiqualitative scoring of radiographic emphysema, markers of pulmonary function, and inflammatory biomarkers. Of the 291 participants, 69 had NCN on chest CT. As previously reported, there was no difference in prevalence of these nodules by HIV status. Emphysema and elevated sCD14 demonstrated an association with NCN in HIV participants independent of smoking status, CD4 cell count, HIV viral load, and pulmonary function. Emphysema and sCD14, a marker of immune activation, was associated with a higher prevalence of NCN on chest CT in HIV participants. Patients with chronic immune activation and emphysema may be at higher risk for both false-positive findings and incident lung cancer, thus screening in this group requires further study to understand the balance of benefits and harms.

  3. Small cell lung cancer transformation from EGFR-mutated lung adenocarcinoma: A case report and literatures review.

    Science.gov (United States)

    Liu, Yangyang

    2018-06-03

    Epithelial growth factor receptor tyrosine kinase inhibitors (EGFR-TKIs) have markedly improved the response of non-small cell lung cancer (NSCLC) with EGFR-mutant patients. However, these patients inevitably come cross acquired resistance to EGFR-TKIs. The transformation of lung adenocarcinoma to small cell lung cancer (SCLC) following treatment with EGFR-TKIs is rare, which leads to resistance to EGFR-TKIs. The present case concerns a case of a 38-year-old man presenting with cough and dyspnea. Radical resection was performed and confirmed an EGFR exon 21 L858R lung adenocarcinoma. However, the patient suffered pleural metastasis after successful treatment with surgery and adjuvant treatment. So, erlotinib was administered with 18 months. Because of enlarged pleural nodule, repeat biopsy identified an SCLC and chemotherapy was started. However, despite the brief success of chemotherapy, our patient suffered brain metastasis. Our case emaphsizes both the profile of transformation from NSCLC to SCLC and the importance of repeat biopsy dealing with drug resistance. We also summarize the clinical characteristics, mechanisms, predictors of SCLC transformation, treatment after transformation and other types of transformation to SCLC.

  4. Parametric features of image textures in 18F-FDG PET/CT evaluation of lung nodules

    International Nuclear Information System (INIS)

    Wang Changmei; Guan Yihui; Zhang Wenqiang; Zuo Chuantao; Hua Fengchun

    2013-01-01

    Objective: To evaluate the parametric features of image textures on 18 F-FDG PET/CT for the differentiation between malignant and benign pulmonary nodules and compare the diagnostic performance of these parameters with SUV max . Methods: 18 F-FDG PET/CT images of 170 patients (102 males, 68 females, age range: 29-81 (mean 59) years) with pulmonary nodules were retrospectively evaluated. Eighty-nine pulmonary nodules (230 slices) were malignant and 81 (193 slices) were benign. The pulmonary nodules were contoured on CT images and mapped to the co-registered PET images. Thirteen parameters of textural features were extracted and SUV max was measured. Logistic regression analysis was used to identify the significant texture parameters and create a regression model. The efficacy of the textural features and SUV max to distinguish between malignant and benign pulmonary nodules was evaluated by ROC curve analysis. The textural features of squamous cell carcinoma and adenocarcinoma were compared via the Mann-Whitney u test. The sensitivity and specificity of the textural features and SUV max for the differential diagnosis were compared with χ 2 test. Results: Logistic regression model identified 4 textural features (skewness (β=1.7058), kurtosis (β=-1.0989), angular second moment (ASM, 3=-4.4140) and strength (β=0.5626); all P<0.05) to have significant correlation with the malignancy of lung nodules. The AUC of ROC curve was 0.775 (95% CI 0.732-0.819; P<0.001) with the sensitivity of 89.6% (206/230) and specificity of 50.8% (98/193). ASM and strength had statistically significant differences between squamous cell carcinoma and adenocarcinoma [ASM: 0.0303 (95% CI 0.0392-0.0724) vs 0.0594 (95% CI 0.0721-0.0947); strength: 2.4714 (95% CI 2.4632-4.1050) vs 1.5945 (95% CI 1.9003-2.4652); u=3082.0 and 3115.0, both P<0.01]. The AUC of SUV max -based diagnosis was 0.757 (95% CI 0.711-0.802; P<0.001) with the sensitivity of 80.9% (186/230) and specificity of 50.3% (97/193) at

  5. Nodule Detection in a Lung Region that's Segmented with Using Genetic Cellular Neural Networks and 3D Template Matching with Fuzzy Rule Based Thresholding

    International Nuclear Information System (INIS)

    Ozekes, Serhat; Osman, Onur; Ucan, N.

    2008-01-01

    The purpose of this study was to develop a new method for automated lung nodule detection in serial section CT images with using the characteristics of the 3D appearance of the nodules that distinguish themselves from the vessels. Lung nodules were detected in four steps. First, to reduce the number of region of interests (ROIs) and the computation time, the lung regions of the CTs were segmented using Genetic Cellular Neural Networks (G-CNN). Then, for each lung region, ROIs were specified with using the 8 directional search; +1 or -1 values were assigned to each voxel. The 3D ROI image was obtained by combining all the 2-Dimensional (2D) ROI images. A 3D template was created to find the nodule-like structures on the 3D ROI image. Convolution of the 3D ROI image with the proposed template strengthens the shapes that are similar to those of the template and it weakens the other ones. Finally, fuzzy rule based thresholding was applied and the ROI's were found. To test the system's efficiency, we used 16 cases with a total of 425 slices, which were taken from the Lung Image Database Consortium (LIDC) dataset. The computer aided diagnosis (CAD) system achieved 100% sensitivity with 13.375 FPs per case when the nodule thickness was greater than or equal to 5.625 mm. Our results indicate that the detection performance of our algorithm is satisfactory, and this may well improve the performance of computer aided detection of lung nodules

  6. Excavated pulmonary nodules: an unusual clinical presentation of lung metastasis in two cases

    Directory of Open Access Journals (Sweden)

    Lalya Issam

    2010-06-01

    Full Text Available Abstract Background Excavated pulmonary metastasis are rare. We present two cases of excavated pulmonary nodules proved to be metastases from osteosarcoma and gallblader lymphoma. Case presentation The first one is 39-year-old man in whom cholecystectomy made the diagnosis of primary non-Hodgkin's lymphoma of the gallbladder. He presented in chest CT scan excavated nodules that had been biopsied and confirmed the diagnosis of non hodgkin lymphoma. He underwent 8 courses of chemotherapy CHOP 21 with complete remission. The second one is an 21 years old man who presented a right leg osteoblastic osteosarcoma with only excavated pulmonary nodules in extension assessment. He had 3 courses of polychemotherapy API (doxorubicin, platinum, and ifosfamide with partial response. Unfortunately, he died following a septic shock. Review of the literature shows that excavated pulmonary nodules as metastasis are rare but we should consider this diagnosis every time we are in front of a cancer. Chest computed tomography is the best diagnosis imaging that could make this diagnosis. Differential diagnosis between benign and malignant bullous lesions is important because surgical excision affects survival in some malignancies. Conclusions Although pulmonary nodules are the most common cancer metastasis, a differential diagnosis of a concurrent primary malignancy should always be considered every time we have excavated lesions, even in patients with known malignant disease. Thorough chest evaluation is important, as multiple primary malignancies may occur concomitantly.

  7. TH-CD-207B-10: Effect of CT Reconstruction Filter On Measured Hounsfield Values in Lung Nodules

    Energy Technology Data Exchange (ETDEWEB)

    Little, K; Reiser, I; Sanchez, A; Chung, J; MacMahon, H; Lu, Z [The University of Chicago, Chicago, IL (United States)

    2016-06-15

    Purpose: Measured Hounsfield numbers in CT are used by radiologists to determine the presence of calcium or fat in lung nodules, either of which suggests a benign diagnosis. However, substantial variations in Hounsfield number may arise due to the use of different reconstruction parameters such as the filter/kernel, leading to measurement inaccuracies. This quality improvement project was developed to demonstrate measurement pitfalls and to identify acceptable conditions for incorporating Hounsfield values as a factor in lung nodule diagnosis. Methods: 12 mm-diameter spheres of polyurethane and urethane foam were placed into an anthropomorphic chest phantom, and 10 mm-diameter tubes with varying iodine concentrations were placed into a 16 cm PMMA cylindrical phantom. Additionally, 11 mm-diameter PMMA and HDPE spheres were placed in a 10 cm PMMA cylindrical phantom. Phantoms were scanned at 120 kVp using a Siemens Biograph mCT and on a Philips iCT and reconstructed using various reconstruction filters. Results: For the Siemens system, both sharp kernels and smooth kernels altered the Hounsfield numbers. Hounsfield numbers varied within a range of 8.9 HU for urethane foam and varied within 58.7 HU for polyurethane. The iodine measurements varied up to 37.9 HU for the lowest concentration. For the Philips system, Hounsfield numbers were relatively consistent but were higher for the “Detail” and “Lung Enhanced” filters, varying by 36.9 HU for PMMA and 15.9 HU for HDPE. Conclusion: Reconstruction filters can change the measured Hounsfield numbers of nodular objects, especially with detail-enhancing (sharpening) filters commonly used in lung imaging. Measured values should only be used for diagnostic decision support with filters that have demonstrated accuracy and consistency. While filter accuracy statements are available from manufacturers, radiologists are likely not aware of the extent of potential variations that can occur in a clinical setting.

  8. Eye-tracking of nodule detection in lung CT volumetric data

    Energy Technology Data Exchange (ETDEWEB)

    Diaz, Ivan; Verdun, Francis R.; Bochud, François O., E-mail: francois.bochud@chuv.ch [Institute of Radiation Physics, Lausanne University Hospital, Lausanne 1004 (Switzerland); Schmidt, Sabine [Department of Radiology, Lausanne University Hospital, Lausanne 1004 (Switzerland)

    2015-06-15

    Purpose: Signal detection on 3D medical images depends on many factors, such as foveal and peripheral vision, the type of signal, and background complexity, and the speed at which the frames are displayed. In this paper, the authors focus on the speed with which radiologists and naïve observers search through medical images. Prior to the study, the authors asked the radiologists to estimate the speed at which they scrolled through CT sets. They gave a subjective estimate of 5 frames per second (fps). The aim of this paper is to measure and analyze the speed with which humans scroll through image stacks, showing a method to visually display the behavior of observers as the search is made as well as measuring the accuracy of the decisions. This information will be useful in the development of model observers, mathematical algorithms that can be used to evaluate diagnostic imaging systems. Methods: The authors performed a series of 3D 4-alternative forced-choice lung nodule detection tasks on volumetric stacks of chest CT images iteratively reconstructed in lung algorithm. The strategy used by three radiologists and three naïve observers was assessed using an eye-tracker in order to establish where their gaze was fixed during the experiment and to verify that when a decision was made, a correct answer was not due only to chance. In a first set of experiments, the observers were restricted to read the images at three fixed speeds of image scrolling and were allowed to see each alternative once. In the second set of experiments, the subjects were allowed to scroll through the image stacks at will with no time or gaze limits. In both static-speed and free-scrolling conditions, the four image stacks were displayed simultaneously. All trials were shown at two different image contrasts. Results: The authors were able to determine a histogram of scrolling speeds in frames per second. The scrolling speed of the naïve observers and the radiologists at the moment the signal

  9. The usefulness of F-18 FDG PET to discriminate between malignant and benign nodule in idiopathic pulmonary fibrosis

    International Nuclear Information System (INIS)

    Kim, Bom Sahn; Kang, Won Jun; Lee, Dong Soo; Chung, June Key; Lee, Myung Chul

    2006-01-01

    Incidence of lung cancer in patients with idiopathic pulmonary fibrosis (IPF) is known to be higher than that in general population. However, it is difficult to discriminate pulmonary nodule in patients with IPF, because underlying IPF can be expressed as lung nodules. We evaluated the diagnostic performance of FDG PET in discriminating lung nodule in patients with IPF. We retrospectively reviewed 28 lung nodules in 16 subjects (age; 67.53 ± 9.83, M:F = 14:2). Two patients had previous history of malignant cancer (small cell lung cancer and subglottic cancer). The diagnostic criteria on chest CT were size, morphology and serial changes of size. FDG PET was visually interpreted, and maximal SUV was calculated for quantitative analysis. From 28 nodules, 18 nodules were interpreted as benign nodules, 10 nodules as malignant nodules by histopathology or follow-up chest CT. The sensitivity and specificity of FDG PET were 100% and 94.4%, while those of CT were 70.0% and 44.4% respectively. Malignant nodule was higher maxSUV than that of benign lung nodules (7.68 ± 3.96 vs 1.22 ± 0.65, p < 0.001). Inflammatory lesion in underlying IPF was significantly lower masSUV than that of malignant nodules (1.80 ± 0.43, p < 0.001). The size of malignant and benign nodule were 23.95 ± 10.15 mm and 10.83 ± 5.23 mm p < 0.01) FDG PET showed superior diagnostic performance to chest CT in differentiating lung nodules in patients with underlying IPF. FDG PET could be used to evaluate suspicious malignant nodule detected by chest in patients with IPF

  10. The usefulness of F-18 FDG PET to discriminate between malignant and benign nodule in idiopathic pulmonary fibrosis

    Energy Technology Data Exchange (ETDEWEB)

    Kim, Bom Sahn; Kang, Won Jun; Lee, Dong Soo; Chung, June Key; Lee, Myung Chul [Seoul National University College of Medicine, Seoul (Korea, Republic of)

    2006-06-15

    Incidence of lung cancer in patients with idiopathic pulmonary fibrosis (IPF) is known to be higher than that in general population. However, it is difficult to discriminate pulmonary nodule in patients with IPF, because underlying IPF can be expressed as lung nodules. We evaluated the diagnostic performance of FDG PET in discriminating lung nodule in patients with IPF. We retrospectively reviewed 28 lung nodules in 16 subjects (age; 67.53 {+-} 9.83, M:F = 14:2). Two patients had previous history of malignant cancer (small cell lung cancer and subglottic cancer). The diagnostic criteria on chest CT were size, morphology and serial changes of size. FDG PET was visually interpreted, and maximal SUV was calculated for quantitative analysis. From 28 nodules, 18 nodules were interpreted as benign nodules, 10 nodules as malignant nodules by histopathology or follow-up chest CT. The sensitivity and specificity of FDG PET were 100% and 94.4%, while those of CT were 70.0% and 44.4% respectively. Malignant nodule was higher maxSUV than that of benign lung nodules (7.68 {+-} 3.96 vs 1.22 {+-} 0.65, p < 0.001). Inflammatory lesion in underlying IPF was significantly lower masSUV than that of malignant nodules (1.80 {+-} 0.43, p < 0.001). The size of malignant and benign nodule were 23.95 {+-} 10.15 mm and 10.83 {+-} 5.23 mm p < 0.01) FDG PET showed superior diagnostic performance to chest CT in differentiating lung nodules in patients with underlying IPF. FDG PET could be used to evaluate suspicious malignant nodule detected by chest in patients with IPF.

  11. Evaluation of effectiveness of a computer system (CAD) in the identification of lung nodules with low-dose MSCT: scanning technique and preliminary results

    International Nuclear Information System (INIS)

    Fraioli, Francesco; Catalano, Carlo; Almberger, Maria; Bertoletti, Linda; Cantisani, Vito; Danti, Massimiliano; Pediconi, Federica; Passariello, Roberto

    2005-01-01

    Purpose: Evaluation of the effectiveness of a computer-aided diagnosis (CAD) in the identification of pulmonary nodules. Materials and methods: Two observers (A1, A2) with different levels of experience independently evaluated 20 chest MSCT studies with and without the aid of a CAD system (LungCheck, R2 Technology, Inc.). The study parameters were as follows: 140 kVs, 40 mAs, collimation 4x1 mm, slice thickness 1.25 mm, reconstruction interval 1.0 mm. The observers analysed the images with and without CAD and evaluated: 1) nodule size (longer axis); 2) number and location of nodules; 3) reading time for each observer. The gold standard was represented by the evaluation of both readers in consensus with the aid of the CAD system. Results: Without CAD support the two readers identified 77 (A1) and 79 (A2) nodules and with CAD 81 (A1) and 82 (A2) nodules. Working in consensus the two observers identified 81 nodules without the aid of CAD and 84 nodules with the aid of CAD. Total number of nodules identified by CAD was 104, 25 of which were false positive and 5 false negative. The average reading time with the aid of CAD decreased by as much as 40% for both the observers. Conclusions: The preliminary results of our study suggest that the CAD technique is an accurate automatic support tool in the identification of pulmonary nodules. It reduces reading time and automatically supplies the size, volume, density and number of nodules, thus being useful both in screening programmes and in the follow-up of cancer patients, in whom comparison of the images is particularly difficult [it

  12. Benefit of computer-aided detection analysis for the detection of subsolid and solid lung nodules on thin- and thick-section CT.

    Science.gov (United States)

    Godoy, Myrna C B; Kim, Tae Jung; White, Charles S; Bogoni, Luca; de Groot, Patricia; Florin, Charles; Obuchowski, Nancy; Babb, James S; Salganicoff, Marcos; Naidich, David P; Anand, Vikram; Park, Sangmin; Vlahos, Ioannis; Ko, Jane P

    2013-01-01

    The objective of our study was to evaluate the impact of computer-aided detection (CAD) on the identification of subsolid and solid lung nodules on thin- and thick-section CT. For 46 chest CT examinations with ground-glass opacity (GGO) nodules, CAD marks computed using thin data were evaluated in two phases. First, four chest radiologists reviewed thin sections (reader(thin)) for nodules and subsequently CAD marks (reader(thin) + CAD(thin)). After 4 months, the same cases were reviewed on thick sections (reader(thick)) and subsequently with CAD marks (reader(thick) + CAD(thick)). Sensitivities were evaluated. Additionally, reader(thick) sensitivity with assessment of CAD marks on thin sections was estimated (reader(thick) + CAD(thin)). For 155 nodules (mean, 5.5 mm; range, 4.0-27.5 mm)-74 solid nodules, 22 part-solid (part-solid nodules), and 59 GGO nodules-CAD stand-alone sensitivity was 80%, 95%, and 71%, respectively, with three false-positives on average (0-12) per CT study. Reader(thin) + CAD(thin) sensitivities were higher than reader(thin) for solid nodules (82% vs 57%, p thick), reader(thick) + CAD(thick), reader(thick) + CAD(thin) were 40%, 58% (p thick); false-positive rates were 1.17, 1.19, and 1.26 per case for reader(thick), reader(thick) + CAD(thick), and reader(thick) + CAD(thin), respectively. Detection of GGO nodules and solid nodules is significantly improved with CAD. When interpretation is performed on thick sections, the benefit is greater when CAD marks are reviewed on thin rather than thick sections.

  13. Cloud-Based NoSQL Open Database of Pulmonary Nodules for Computer-Aided Lung Cancer Diagnosis and Reproducible Research.

    Science.gov (United States)

    Ferreira Junior, José Raniery; Oliveira, Marcelo Costa; de Azevedo-Marques, Paulo Mazzoncini

    2016-12-01

    Lung cancer is the leading cause of cancer-related deaths in the world, and its main manifestation is pulmonary nodules. Detection and classification of pulmonary nodules are challenging tasks that must be done by qualified specialists, but image interpretation errors make those tasks difficult. In order to aid radiologists on those hard tasks, it is important to integrate the computer-based tools with the lesion detection, pathology diagnosis, and image interpretation processes. However, computer-aided diagnosis research faces the problem of not having enough shared medical reference data for the development, testing, and evaluation of computational methods for diagnosis. In order to minimize this problem, this paper presents a public nonrelational document-oriented cloud-based database of pulmonary nodules characterized by 3D texture attributes, identified by experienced radiologists and classified in nine different subjective characteristics by the same specialists. Our goal with the development of this database is to improve computer-aided lung cancer diagnosis and pulmonary nodule detection and classification research through the deployment of this database in a cloud Database as a Service framework. Pulmonary nodule data was provided by the Lung Image Database Consortium and Image Database Resource Initiative (LIDC-IDRI), image descriptors were acquired by a volumetric texture analysis, and database schema was developed using a document-oriented Not only Structured Query Language (NoSQL) approach. The proposed database is now with 379 exams, 838 nodules, and 8237 images, 4029 of them are CT scans and 4208 manually segmented nodules, and it is allocated in a MongoDB instance on a cloud infrastructure.

  14. Malignancy risk estimation of screen-detected nodules at baseline CT: comparison of the PanCan model, Lung-RADS and NCCN guidelines

    Energy Technology Data Exchange (ETDEWEB)

    Riel, Sarah J. van; Ciompi, Francesco; Jacobs, Colin; Scholten, Ernst T.; Prokop, Mathias; Ginneken, Bram van [Radboud University Nijmegen Medical Center, Department of Radiology and Nuclear Medicine, Nijmegen (Netherlands); Winkler Wille, Mathilde M.; Naqibullah, Matiullah [University of Copenhagen, Department of Pulmonology Gentofte Hospital, Hellerup (Denmark); Lam, Stephen [British Columbia Cancer Agency, Department of Integrative Oncology, Vancouver, British Columbia (Canada); Schaefer-Prokop, Cornelia [Radboud University Nijmegen Medical Center, Department of Radiology and Nuclear Medicine, Nijmegen (Netherlands); Meander Medical Center, Department of Radiology, Amersfoort (Netherlands)

    2017-10-15

    To compare the PanCan model, Lung-RADS and the 1.2016 National Comprehensive Cancer Network (NCCN) guidelines for discriminating malignant from benign pulmonary nodules on baseline screening CT scans and the impact diameter measurement methods have on performances. From the Danish Lung Cancer Screening Trial database, 64 CTs with malignant nodules and 549 baseline CTs with benign nodules were included. Performance of the systems was evaluated applying the system's original diameter definitions: D{sup longest-C} (PanCan), D{sup meanAxial} (NCCN), both obtained from axial sections, and D{sup mean3D} (Lung-RADS). Subsequently all diameter definitions were applied uniformly to all systems. Areas under the ROC curves (AUC) were used to evaluate risk discrimination. PanCan performed superiorly to Lung-RADS and NCCN (AUC 0.874 vs. 0.813, p = 0.003; 0.874 vs. 0.836, p = 0.010), using the original diameter specifications. When uniformly applying D{sup longest-C}, D{sup mean3D} and D{sup meanAxial}, PanCan remained superior to Lung-RADS (p < 0.001 - p = 0.001) and NCCN (p < 0.001 - p = 0.016). Diameter definition significantly influenced NCCN's performance with D{sup longest-C} being the worst (D{sup longest-C} vs. D{sup mean3D}, p = 0.005; D{sup longest-C} vs. D{sup meanAxial}, p = 0.016). Without follow-up information, the PanCan model performs significantly superiorly to Lung-RADS and the 1.2016 NCCN guidelines for discriminating benign from malignant nodules. The NCCN guidelines are most sensitive to nodule size definition. (orig.)

  15. TU-G-204-09: The Effects of Reduced- Dose Lung Cancer Screening CT On Lung Nodule Detection Using a CAD Algorithm

    Energy Technology Data Exchange (ETDEWEB)

    Young, S; Lo, P; Kim, G; Hsu, W; Hoffman, J; Brown, M; McNitt-Gray, M [UCLA School of Medicine, Los Angeles, CA (United States)

    2015-06-15

    Purpose: While Lung Cancer Screening CT is being performed at low doses, the purpose of this study was to investigate the effects of further reducing dose on the performance of a CAD nodule-detection algorithm. Methods: We selected 50 cases from our local database of National Lung Screening Trial (NLST) patients for which we had both the image series and the raw CT data from the original scans. All scans were acquired with fixed mAs (25 for standard-sized patients, 40 for large patients) on a 64-slice scanner (Sensation 64, Siemens Healthcare). All images were reconstructed with 1-mm slice thickness, B50 kernel. 10 of the cases had at least one nodule reported on the NLST reader forms. Based on a previously-published technique, we added noise to the raw data to simulate reduced-dose versions of each case at 50% and 25% of the original NLST dose (i.e. approximately 1.0 and 0.5 mGy CTDIvol). For each case at each dose level, the CAD detection algorithm was run and nodules greater than 4 mm in diameter were reported. These CAD results were compared to “truth”, defined as the approximate nodule centroids from the NLST reports. Subject-level mean sensitivities and false-positive rates were calculated for each dose level. Results: The mean sensitivities of the CAD algorithm were 35% at the original dose, 20% at 50% dose, and 42.5% at 25% dose. The false-positive rates, in decreasing-dose order, were 3.7, 2.9, and 10 per case. In certain cases, particularly in larger patients, there were severe photon-starvation artifacts, especially in the apical region due to the high-attenuating shoulders. Conclusion: The detection task was challenging for the CAD algorithm at all dose levels, including the original NLST dose. However, the false-positive rate at 25% dose approximately tripled, suggesting a loss of CAD robustness somewhere between 0.5 and 1.0 mGy. NCI grant U01 CA181156 (Quantitative Imaging Network); Tobacco Related Disease Research Project grant 22RT-0131.

  16. TU-G-204-09: The Effects of Reduced- Dose Lung Cancer Screening CT On Lung Nodule Detection Using a CAD Algorithm

    International Nuclear Information System (INIS)

    Young, S; Lo, P; Kim, G; Hsu, W; Hoffman, J; Brown, M; McNitt-Gray, M

    2015-01-01

    Purpose: While Lung Cancer Screening CT is being performed at low doses, the purpose of this study was to investigate the effects of further reducing dose on the performance of a CAD nodule-detection algorithm. Methods: We selected 50 cases from our local database of National Lung Screening Trial (NLST) patients for which we had both the image series and the raw CT data from the original scans. All scans were acquired with fixed mAs (25 for standard-sized patients, 40 for large patients) on a 64-slice scanner (Sensation 64, Siemens Healthcare). All images were reconstructed with 1-mm slice thickness, B50 kernel. 10 of the cases had at least one nodule reported on the NLST reader forms. Based on a previously-published technique, we added noise to the raw data to simulate reduced-dose versions of each case at 50% and 25% of the original NLST dose (i.e. approximately 1.0 and 0.5 mGy CTDIvol). For each case at each dose level, the CAD detection algorithm was run and nodules greater than 4 mm in diameter were reported. These CAD results were compared to “truth”, defined as the approximate nodule centroids from the NLST reports. Subject-level mean sensitivities and false-positive rates were calculated for each dose level. Results: The mean sensitivities of the CAD algorithm were 35% at the original dose, 20% at 50% dose, and 42.5% at 25% dose. The false-positive rates, in decreasing-dose order, were 3.7, 2.9, and 10 per case. In certain cases, particularly in larger patients, there were severe photon-starvation artifacts, especially in the apical region due to the high-attenuating shoulders. Conclusion: The detection task was challenging for the CAD algorithm at all dose levels, including the original NLST dose. However, the false-positive rate at 25% dose approximately tripled, suggesting a loss of CAD robustness somewhere between 0.5 and 1.0 mGy. NCI grant U01 CA181156 (Quantitative Imaging Network); Tobacco Related Disease Research Project grant 22RT-0131

  17. CT radiogenomic characterization of EGFR, K-RAS, and ALK mutations in non-small cell lung cancer

    Energy Technology Data Exchange (ETDEWEB)

    Rizzo, Stefania; Rampinelli, Cristiano [European Institute of Oncology, Department of Radiology, Milan (Italy); Petrella, Francesco; Spaggiari, Lorenzo [European Institute of Oncology, Department of Thoracic Surgery, Milan (Italy); Buscarino, Valentina; De Maria, Federica [University of Milan, Department of Health Sciences, Milan (Italy); Raimondi, Sara [European Institute of Oncology, Department of Epidemiology and Biostatistics, Milan (Italy); Barberis, Massimo; Fumagalli, Caterina [European Institute of Oncology, Department of Pathology, Milan (Italy); Spitaleri, Gianluca; De Marinis, Filippo [European Institute of Oncology, Department of Thoracic Oncology, Milan (Italy); Bellomi, Massimo [European Institute of Oncology, Department of Radiology, Milan (Italy); University of Milan, Department of Health Sciences, Milan (Italy)

    2016-01-15

    To assess the association between CT features and EGFR, ALK, KRAS mutations in non-small cell lung cancer. Patients undergoing chest CT and testing for the above gene mutations were included. Qualitative evaluation of CTs included: lobe; lesion diameter; shape; margins; ground-glass opacity; density; cavitation; air bronchogram; pleural thickening; intratumoral necrosis; nodules in tumour lobe; nodules in non-tumour lobes; pleural retraction; location; calcifications; emphysema; fibrosis; pleural contact; pleural effusion. Statistical analysis was performed to assess association of features with each gene mutation. ROC curves for gene mutations were drawn; the corresponding area under the curve was calculated. P-values <0.05 were considered significant. Of 285 patients, 60/280 (21.43 %) were positive for EGFR mutation; 31/270 (11.48 %) for ALK rearrangement; 64/240 (26.67 %) for KRAS mutation. EGFR mutation was associated with air bronchogram, pleural retraction, females, non-smokers, small lesion size, and absence of fibrosis. ALK rearrangements were associated with age and pleural effusion. KRAS mutation was associated with round shape, nodules in non-tumour lobes, and smoking. This study disclosed associations between CT features and alterations of EGFR (air bronchogram, pleural retraction, small lesion size, absence of fibrosis), ALK (pleural effusion) and KRAS (round lesion shape, nodules in non-tumour lobes). (orig.)

  18. Novel high-resolution computed tomography-based radiomic classifier for screen-identified pulmonary nodules in the National Lung Screening Trial.

    Science.gov (United States)

    Peikert, Tobias; Duan, Fenghai; Rajagopalan, Srinivasan; Karwoski, Ronald A; Clay, Ryan; Robb, Richard A; Qin, Ziling; Sicks, JoRean; Bartholmai, Brian J; Maldonado, Fabien

    2018-01-01

    Optimization of the clinical management of screen-detected lung nodules is needed to avoid unnecessary diagnostic interventions. Herein we demonstrate the potential value of a novel radiomics-based approach for the classification of screen-detected indeterminate nodules. Independent quantitative variables assessing various radiologic nodule features such as sphericity, flatness, elongation, spiculation, lobulation and curvature were developed from the NLST dataset using 726 indeterminate nodules (all ≥ 7 mm, benign, n = 318 and malignant, n = 408). Multivariate analysis was performed using least absolute shrinkage and selection operator (LASSO) method for variable selection and regularization in order to enhance the prediction accuracy and interpretability of the multivariate model. The bootstrapping method was then applied for the internal validation and the optimism-corrected AUC was reported for the final model. Eight of the originally considered 57 quantitative radiologic features were selected by LASSO multivariate modeling. These 8 features include variables capturing Location: vertical location (Offset carina centroid z), Size: volume estimate (Minimum enclosing brick), Shape: flatness, Density: texture analysis (Score Indicative of Lesion/Lung Aggression/Abnormality (SILA) texture), and surface characteristics: surface complexity (Maximum shape index and Average shape index), and estimates of surface curvature (Average positive mean curvature and Minimum mean curvature), all with Pscreen-detected nodule characterization appears extremely promising however independent external validation is needed.

  19. Effects of Different Reconstruction Parameters on CT Volumetric Measurement 
of Pulmonary Nodules

    Directory of Open Access Journals (Sweden)

    Rongrong YANG

    2012-02-01

    Full Text Available Background and objective It has been proven that volumetric measurements could detect subtle changes in small pulmonary nodules in serial CT scans, and thus may play an important role in the follow-up of indeterminate pulmonary nodules and in differentiating malignant nodules from benign nodules. The current study aims to evaluate the effects of different reconstruction parameters on the volumetric measurements of pulmonary nodules in chest CT scans. Methods Thirty subjects who underwent chest CT scan because of indeterminate pulmonary nodules in General Hospital of Tianjin Medical University from December 2009 to August 2011 were retrospectively analyzed. A total of 52 pulmonary nodules were included, and all CT data were reconstructed using three reconstruction algorithms and three slice thicknesses. The volumetric measurements of the nodules were performed using the advanced lung analysis (ALA software. The effects of the reconstruction algorithms, slice thicknesses, and nodule diameters on the volumetric measurements were assessed using the multivariate analysis of variance for repeated measures, the correlation analysis, and the Bland-Altman method. Results The reconstruction algorithms (F=13.6, P<0.001 and slice thicknesses (F=4.4, P=0.02 had significant effects on the measured volume of pulmonary nodules. In addition, the coefficients of variation of nine measurements were inversely related with nodule diameter (r=-0.814, P<0.001. The volume measured at the 2.5 mm slice thickness had poor agreement with the volumes measured at 1.25 mm and 0.625 mm, respectively. Moreover, the best agreement was achieved between the slice thicknesses of 1.25 mm and 0.625 mm using the bone algorithm. Conclusion Reconstruction algorithms and slice thicknesses have significant impacts on the volumetric measurements of lung nodules, especially for the small nodules. Therefore, the reconstruction setting in serial CT scans should be consistent in the follow

  20. Clinical impact of abnormal FDG uptake in pulmonary nodules detected by CT in patients with only history of non-lung cancers

    International Nuclear Information System (INIS)

    Wong, C.O.; Nunez, R.; Welsh, R.J.; Chmielewski, G.W.; Hill, E.A.; Hill, J.C.; Ravikrishnan, K.P.; Darlene Fink-Bennett; Dworkin, H.J.

    2001-01-01

    Objective: The aim is to assess the clinical impact of positive FDG uptake in single (SPN) or multiple (MPN) pulmonary nodules detected by CT in patients with known past history of non-lung cancers (but no known lung cancers). Materials and Methods: Twenty-eight sequential patients with non-lung cancers (15 breast, 8 colon, 5 prostate) referred for evaluation of SPN or MPN by PET over a period of two years were included. F-18 FDG PET images, covering chest and upper abdomen, were interpreted blindly and then correlated with CT findings for the precise location of abnormal FDG uptake in the chest. Results: There was a significant number of abnormal FDG uptake in both SPN or MPN. Positive abnormal uptake suggestive of malignancy was found in 25% of patients in the form of SPN and 39% of patients in the form of MPN (p<0.03). Positive cases in the pattern of multiple foci of pulmonary uptake were attributed to metastatic disease. Otherwise positive cases were followed by tissue diagnosis and/or surgical attention. The negative cases were followed clinically. Of the 11 positive cases of MPN, 2 patients (18%) showed only abnormal FDG uptake in just one of the nodules, which was later confirmed at surgery to be a primary cancer of lung in both patients. Conclusion: These results suggest that PET scan would be just as useful in patients with SPN and known non-lung cancers as other patients with no history of any cancers. Not all patients with non-lung cancer and MPN have pulmonary metastasis by PET criteria. PET may single out a primary lung malignancy in patients with non-lung cancer and MPN. PET has thus great clinical impact in these patients with pulmonary nodules and known non-lung cancers as the management would otherwise be completely different in situations revealed by the study

  1. A Case of Non-Small Cell Lung Cancer with Possible “Disease Flare” on Nivolumab Treatment

    Directory of Open Access Journals (Sweden)

    Shotaro Chubachi

    2016-01-01

    Full Text Available Background. Recent clinical trials proven the clinically significant efficacy and tolerability of nivolumab, a programmed death 1 (PD-1 inhibitor, in previously treated patients with non-small cell lung cancer (NSCLC. Case Presentation. Here, we describe the case of a patient who experienced possible “disease flare” immediately after initiation of nivolumab treatment. A 54-year-old man was diagnosed with Stage IIB (T2N1M0 lung adenocarcinoma. After 7 years from recurrence, 10th line chemotherapy, nivolumab, was initiated. Six weeks later, after 3 cycles of nivolumab treatment, rapid lung cancer progression was observed with an increase in the size of the primary lesion, multiple novel nodules on both lungs, and multiple novel brain metastases. Conclusion. We believe that physicians should be made aware that, in a subset of NSCLC patients, disease flare might occur on nivolumab treatment.

  2. CT fluoroscopy guided transpleural cutting needle biopsy of small ({<=}2.5 cm) subpleural pulmonary nodules

    Energy Technology Data Exchange (ETDEWEB)

    Prosch, Helmut; Oschatz, Elisabeth; Eisenhuber, Edith; Wohlschlager, Helmut [Otto Wagner Hospital, Department of Radiology, Sanatoriumsstrasse 2, 1140 Vienna (Austria); Mostbeck, Gerhard H., E-mail: gerhard.mostbeck@wienkav.at [Otto Wagner Hospital, Department of Radiology, Sanatoriumsstrasse 2, 1140 Vienna (Austria)

    2011-01-15

    Purpose: Small subpleural pulmonary lesions are difficult to biopsy. While the direct, short needle path has been reported to have a lower rate of pneumothorax, the indirect path provides a higher diagnostic yield. Therefore, we tried to optimize the needle pathway and minimize the iatrogenic pneumothorax risk by evaluating a CT fluoroscopy guided direct approach to biopsy subpleural lesions. Material and methods: Between 01/2005 and 01/2007, CT fluoroscopy guided core biopsies were performed in 24 patients. Using our technique, the tip of the guide needle remains outside the visceral pleura (17 G coaxial guide needle, 18 G Biopsy-gun, 15 or 22 mm needle path). The position of the lesion relative to the needle tip can be optimized using CT fluoroscopy by adjusting the breathing position of the patient. The Biopty gun is fired with the needle tip still outside the pleural space. Cytological smears are analyzed by a cytopathologist on-site, and biopsies are repeated as indicated with the coaxial needle still outside the pleura. Results: Median nodule size was 1.6 cm (0.7-2.3 cm). A definitive diagnosis was obtained in 22 patients by histology and/or cytology. In one patient, only necrotic material could be obtained. In another patient, the intervention had to be aborted as the dyspnoic patient could not follow breathing instructions. An asymptomatic pneumothorax was present in seven patients; chest tube placement was not required. Conclusion: The presented biopsy approach has a high diagnostic yield and is especially advantageous for biopsies of small subpleural lesions in the lower lobes.

  3. Treatment of stage III non-small cell lung cancer and limited-disease small-cell lung cancer

    NARCIS (Netherlands)

    El Sharouni, S.Y.

    2009-01-01

    This thesis concerns the treatment of stage III non-small cell lung cancer (NSCLC) and limited disease small-cell lung cancer (SCLC). We described a systematic review on the clinical results of radiotherapy, combined or not with chemotherapy, for inoperable NSCLC stage III with the aim to define the

  4. Development and evaluation of a computer-aided diagnostic scheme for lung nodule detection in chest radiographs by means of two-stage nodule enhancement with support vector classification

    International Nuclear Information System (INIS)

    Chen Sheng; Suzuki, Kenji; MacMahon, Heber

    2011-01-01

    Purpose: To develop a computer-aided detection (CADe) scheme for nodules in chest radiographs (CXRs) with a high sensitivity and a low false-positive (FP) rate. Methods: The authors developed a CADe scheme consisting of five major steps, which were developed for improving the overall performance of CADe schemes. First, to segment the lung fields accurately, the authors developed a multisegment active shape model. Then, a two-stage nodule-enhancement technique was developed for improving the conspicuity of nodules. Initial nodule candidates were detected and segmented by using the clustering watershed algorithm. Thirty-one shape-, gray-level-, surface-, and gradient-based features were extracted from each segmented candidate for determining the feature space, including one of the new features based on the Canny edge detector to eliminate a major FP source caused by rib crossings. Finally, a nonlinear support vector machine (SVM) with a Gaussian kernel was employed for classification of the nodule candidates. Results: To evaluate and compare the scheme to other published CADe schemes, the authors used a publicly available database containing 140 nodules in 140 CXRs and 93 normal CXRs. The CADe scheme based on the SVM classifier achieved sensitivities of 78.6% (110/140) and 71.4% (100/140) with averages of 5.0 (1165/233) FPs/image and 2.0 (466/233) FPs/image, respectively, in a leave-one-out cross-validation test, whereas the CADe scheme based on a linear discriminant analysis classifier had a sensitivity of 60.7% (85/140) at an FP rate of 5.0 FPs/image. For nodules classified as ''very subtle'' and ''extremely subtle,'' a sensitivity of 57.1% (24/42) was achieved at an FP rate of 5.0 FPs/image. When the authors used a database developed at the University of Chicago, the sensitivities was 83.3% (40/48) and 77.1% (37/48) at an FP rate of 5.0 (240/48) FPs/image and 2.0 (96/48) FPs /image, respectively. Conclusions: These results compare favorably to those described for

  5. Seven-microRNA panel for lung adenocarcinoma early diagnosis in patients presenting with ground-glass nodules

    Directory of Open Access Journals (Sweden)

    He Y

    2017-12-01

    Full Text Available Yayi He,1,2,* Yang Yang,3,* Peng Kuang,1 Shengxiang Ren,1 Leslie Rozeboom,2 Christopher J Rivard,2 Xuefei Li,4 Caicun Zhou,1 Fred R Hirsch2 1Department of Medical Oncology, Shanghai Pulmonary Hospital, Tongji University Medical School Cancer Institute, Tongji University School of Medicine, Shanghai, People’s Republic of China; 2Division of Medical Oncology, Department of Medicine, University of Colorado Anschutz Medical Campus, Aurora, CO, USA; 3Department of Surgery, Shanghai Pulmonary Hospital, Tongji University Medical School Cancer Institute, Tongji University School of Medicine, 4Department of Lung Cancer and Immunology, Shanghai Pulmonary Hospital, Tongji University Medical School Cancer Institute, Tongji University School of Medicine, Shanghai, People’s Republic of China *These authors contributed equally to this work Background: MicroRNA (miRNA expression is correlated with tumor histology, differentiation, invasiveness and treatment outcome. We aimed to identify miRNAs whose differential expression might enable early diagnosis of lung adenocarcinoma in patients presenting with ground-glass nodules (GGNs.Methods: To identify potential miRNAs of interest, we analyzed the miRNA expression profile of tumor and adjacent non-para-tumor tissue in three participants by next-generation sequencing (NGS. We then assessed the expression levels of the miRNAs of interest in 73 lung adenocarcinomas presenting with GGNs with matched adjacent non-tumor tissue by quantitative real-time polymerase chain reaction (qRT-PCR. We also detected the miRNA panel in 66 lung benign diseases and 66 lung adenocarcinomas presenting with GGN lesion tissues by qRT-PCR. Target genes of our selected miRNA panel were predicted using Miranda with default parameters.Results: Twenty-three miRNAs showed differential expression between tumor and adjacent non-tumor tissue by NGS. Five miRNAs exhibited higher expression in tumor tissue compared to adjacent non-tumor tissue (P

  6. Role of Computer Aided Diagnosis (CAD) in the detection of pulmonary nodules on 64 row multi detector computed tomography.

    Science.gov (United States)

    Prakashini, K; Babu, Satish; Rajgopal, K V; Kokila, K Raja

    2016-01-01

    To determine the overall performance of an existing CAD algorithm with thin-section computed tomography (CT) in the detection of pulmonary nodules and to evaluate detection sensitivity at a varying range of nodule density, size, and location. A cross-sectional prospective study was conducted on 20 patients with 322 suspected nodules who underwent diagnostic chest imaging using 64-row multi-detector CT. The examinations were evaluated on reconstructed images of 1.4 mm thickness and 0.7 mm interval. Detection of pulmonary nodules, initially by a radiologist of 2 years experience (RAD) and later by CAD lung nodule software was assessed. Then, CAD nodule candidates were accepted or rejected accordingly. Detected nodules were classified based on their size, density, and location. The performance of the RAD and CAD system was compared with the gold standard that is true nodules confirmed by consensus of senior RAD and CAD together. The overall sensitivity and false-positive (FP) rate of CAD software was calculated. Of the 322 suspected nodules, 221 were classified as true nodules on the consensus of senior RAD and CAD together. Of the true nodules, the RAD detected 206 (93.2%) and 202 (91.4%) by the CAD. CAD and RAD together picked up more number of nodules than either CAD or RAD alone. Overall sensitivity for nodule detection with the CAD program was 91.4%, and FP detection per patient was 5.5%. The CAD showed comparatively higher sensitivity for nodules of size 4-10 mm (93.4%) and nodules in hilar (100%) and central (96.5%) location when compared to RAD's performance. CAD performance was high in detecting pulmonary nodules including the small size and low-density nodules. CAD even with relatively high FP rate, assists and improves RAD's performance as a second reader, especially for nodules located in the central and hilar region and for small nodules by saving RADs time.

  7. A comparison of six software packages for evaluation of solid lung nodules using semi-automated volumetry: What is the minimum increase in size to detect growth in repeated CT examinations

    International Nuclear Information System (INIS)

    Hoop, Bartjan de; Gietema, Hester; Prokop, Mathias; Ginneken, Bram van; Zanen, Pieter; Groenewegen, Gerard

    2009-01-01

    We compared interexamination variability of CT lung nodule volumetry with six currently available semi-automated software packages to determine the minimum change needed to detect the growth of solid lung nodules. We had ethics committee approval. To simulate a follow-up examination with zero growth, we performed two low-dose unenhanced CT scans in 20 patients referred for pulmonary metastases. Between examinations, patients got off and on the table. Volumes of all pulmonary nodules were determined on both examinations using six nodule evaluation software packages. Variability (upper limit of the 95% confidence interval of the Bland-Altman plot) was calculated for nodules for which segmentation was visually rated as adequate. We evaluated 214 nodules (mean diameter 10.9 mm, range 3.3 mm-30.0 mm). Software packages provided adequate segmentation in 71% to 86% of nodules (p < 0.001). In case of adequate segmentation, variability in volumetry between scans ranged from 16.4% to 22.3% for the various software packages. Variability with five to six software packages was significantly less for nodules ≥8 mm in diameter (range 12.9%-17.1%) than for nodules <8 mm (range 18.5%-25.6%). Segmented volumes of each package were compared to each of the other packages. Systematic volume differences were detected in 11/15 comparisons. This hampers comparison of nodule volumes between software packages. (orig.)

  8. Autopsy findings in small cell lung cancer

    International Nuclear Information System (INIS)

    Jereczek, B.; Jassem, J.; Karnicka-Mlodkowska, H.; Badzio, A.; Mos-Antkowiak, R.; Dziadziuszko, R.; Szczepek, B.; Chojak, E.; Lisowska, B.; Malak, K.

    1996-01-01

    The objective of this study was to assess the pattern of autopsy in 174 small lung cancer patients treated between 1971 and 1991 at seven Polish medical centres. Eighty nine autopsied patients were previously treated with different chemotherapy regimens including 32 patients who also received chest irradiation, 74 received only supportive care and for 11 patients the data on treatment were not available. The age range at diagnosis was 28-81 years (median 57); there were 39 females (22%) and 135 males (78%). Seventy two patients had limited disease at the time of diagnosis, 86 - extensive disease and in 16 the disease extent was not determined. The primary tumor and/or metastases in regional lymph nodes were present in 157 autopsies (90%). There was a significant difference in the rate of locoregional disease found at autopsy in patients given chemotherapy and in those who received only supportive care (85% and 100%, respectively; p = 0.01). Chest radiation therapy given in limited as an adjunct to chemotherapy did not decrease the rate of persistent locoregional disease (primary tumor in the chest was found in 92% of irradiated and in 96% of nonirradiated patients). Locoregional tumor deposit only was found in 28 (16%). Distant metastases were distributed in 143 patients (82%) and were found in 25 different locations, most frequently in liver (49%), supra-renal glands (25%), peripheral lymph nodes (21%), kidneys (18%), brain (17%) and pancreas (12%). In 3 patients no tumor foci were found. The number of organs involved varied between 0 and 10 (median 3). The number of involved organs was not dependent on the disease extent at the time of diagnosis and on the type of treatment. (author)

  9. Computer-aided detection of lung nodules on multidetector CT in concurrent-reader and second-reader modes: A comparative study

    International Nuclear Information System (INIS)

    Matsumoto, Sumiaki; Ohno, Yoshiharu; Aoki, Takatoshi; Yamagata, Hitoshi; Nogami, Munenobu; Matsumoto, Keiko; Yamashita, Yoshiko; Sugimura, Kazuro

    2013-01-01

    Purpose: To compare the reading times and detection performances of radiologists in concurrent-reader and second-reader modes of computer-aided detection (CAD) for lung nodules on multidetector computed tomography (CT). Materials and Methods: Fifty clinical multidetector CT datasets containing nodules up to 20 mm in diameter were retrospectively collected. For the detection and rating of non-calcified nodules larger than 4 mm in diameter, 6 radiologists (3 experienced radiologists and 3 resident radiologists) independently interpreted these datasets twice, once with concurrent-reader CAD and once with second-reader CAD. The reference standard of nodules in the datasets was determined by the consensus of two experienced chest radiologists. The reading times and detection performances in the two modes of CAD were statistically compared, where jackknife free-response receiver operating characteristic (JAFROC) analysis was used for the comparison of detection performances. Results: Two hundreds and seven nodules constituted the reference standard. Reading time was significantly shorter in the concurrent-reader mode than in the second-reader mode, with the mean reading time for the 6 radiologists being 132 s with concurrent-reader CAD and 210 s with second-reader CAD (p < 0.01). JAFROC analysis revealed no significant difference between the detection performances in the two modes, with the average figure-of-merit value for the 6 radiologists being 0.70 with concurrent-reader CAD and 0.72 with second-reader CAD (p = 0.35). Conclusion: In CAD for lung nodules on multidetector CT, the concurrent-reader mode is more time-efficient than the second-reader mode, and there can be no significant difference between the two modes in terms of detection performance of radiologists

  10. Erlotinib in previously treated non-small-cell lung cancer

    International Nuclear Information System (INIS)

    Smrdel, U.; Kovac, V.

    2006-01-01

    Background. Erlotinib is a novel biological anti-tumour agent in the treatment of advanced non small cell lung cancer. It represents the molecularly-targeted therapy which has been studied extensively. Case report. We present a case of a patient who suffered from advanced non-small-cell lung cancer. After the progress of disease following a prior chemotherapy he was treated with erlotinib with remarkable effect which was shown at chest x ray and symptoms were quite reduced. Conclusions. In selected patients with advanced non-small-cell lung cancer Erlotinib improves survival and symptom control as it results in presented case. (author)

  11. Computer-aided detection (CAD) of lung nodules in CT scans: radiologist performance and reading time with incremental CAD assistance

    International Nuclear Information System (INIS)

    Roos, Justus E.; Paik, David; Olsen, David; Liu, Emily G.; Leung, Ann N.; Mindelzun, Robert; Choudhury, Kingshuk R.; Napel, Sandy; Rubin, Geoffrey D.; Chow, Lawrence C.; Naidich, David P.

    2010-01-01

    The diagnostic performance of radiologists using incremental CAD assistance for lung nodule detection on CT and their temporal variation in performance during CAD evaluation was assessed. CAD was applied to 20 chest multidetector-row computed tomography (MDCT) scans containing 190 non-calcified ≥3-mm nodules. After free search, three radiologists independently evaluated a maximum of up to 50 CAD detections/patient. Multiple free-response ROC curves were generated for free search and successive CAD evaluation, by incrementally adding CAD detections one at a time to the radiologists' performance. The sensitivity for free search was 53% (range, 44%-59%) at 1.15 false positives (FP)/patient and increased with CAD to 69% (range, 59-82%) at 1.45 FP/patient. CAD evaluation initially resulted in a sharp rise in sensitivity of 14% with a minimal increase in FP over a time period of 100 s, followed by flattening of the sensitivity increase to only 2%. This transition resulted from a greater prevalence of true positive (TP) versus FP detections at early CAD evaluation and not by a temporal change in readers' performance. The time spent for TP (9.5 s ± 4.5 s) and false negative (FN) (8.4 s ± 6.7 s) detections was similar; FP decisions took two- to three-times longer (14.4 s ± 8.7 s) than true negative (TN) decisions (4.7 s ± 1.3 s). When CAD output is ordered by CAD score, an initial period of rapid performance improvement slows significantly over time because of non-uniformity in the distribution of TP CAD output and not to a changing reader performance over time. (orig.)

  12. Computer-aided detection and automated CT volumetry of pulmonary nodules

    International Nuclear Information System (INIS)

    Marten, Katharina; Engelke, Christoph

    2007-01-01

    With use of multislice computed tomography (MSCT), small pulmonary nodules are being detected in vast numbers, constituting the majority of all noncalcified lung nodules. Although the prevalence of lung cancers among such lesions in lung cancer screening populations is low, their isolation may contribute to increased patient survival. Computer-aided diagnosis (CAD) has emerged as a diverse set of diagnostic tools to handle the large number of images in MSCT datasets and most importantly, includes automated detection and volumetry of pulmonary nodules. Current CAD systems can significantly enhance experienced radiologists' performance and outweigh human limitations in identifying small lesions and manually measuring their diameters, augment observer consistency in the interpretation of such examinations and may thus help to detect significantly higher rates of early malignomas and give more precise estimates on chemotherapy response than can radiologists alone. In this review, we give an overview of current CAD in lung nodule detection and volumetry and discuss their relative merits and limitations. (orig.)

  13. Role of -FDG PET Scan in Rheumatoid Lung Nodule: Case Report and Review of the Literature

    Directory of Open Access Journals (Sweden)

    Christine L. Chhakchhuak

    2013-01-01

    Full Text Available Flourine-18 fluoro-2-deoxy-glucose (18F-FDG positron emission tomography combined with computed tomography (PET/CT is a useful test for the management of malignant conditions. Inflammatory and infectious processes, however, can cause increased uptake on PET scanning, often causing diagnostic dilemmas. This knowledge is important to the rheumatologist not only because of the inflammatory conditions we treat but also because certain rheumatic diseases impose an increased risk of malignancy either due to the disease itself or as a consequence of medications used to treat the rheumatic diseases. There is an increasing body of evidence investigating the role of PET scans in inflammatory conditions. This paper describes a patient with rheumatoid arthritis who developed pulmonary nodules that showed increased uptake on PET/CT scan and reviews the use of PET scanning in the diagnosis and management of rheumatoid arthritis.

  14. Computational investigation of small RNAs in the establishment of root nodules and arbuscular mycorrhiza in leguminous plants.

    Science.gov (United States)

    Jin, Danfeng; Meng, Xianwen; Wang, Yue; Wang, Jingjing; Zhao, Yuhua; Chen, Ming

    2018-01-03

    Many small RNAs have been confirmed to play important roles in the development of root nodules and arbuscular mycorrhiza. In this study, we carried out the identification of certain small RNAs in leguminous plants (Medicago truncatula, soybean, peanut and common bean), such as miRNAs, tRFs and srRNAs, as well as the computational investigation of their regulations. Thirty miRNAs were predicted to be involved in establishing root nodules and mycorrhiza, and 12 of them were novel in common bean and peanut. The generation of tRFs in M. truncatula was not associated with tRNA gene frequencies and codon usage. Six tRFs exhibited different expressions in mycorrhiza and root nodules. Moreover, srRNA 5.8S in M. truncatula was generated from the regions with relatively low conservation at the rRNA 3' terminal. The protein-protein interactions between the proteins encoded by the target genes of miRNAs, tRFs and srRNAs were computed. The regulation of these three types of sRNAs in the symbiosis between leguminous plants and microorganisms is not a single regulation of certain signaling or metabolic pathways but a global regulation for the plants to own growth or specific events in symbiosis.

  15. Computer-aided detection of artificial pulmonary nodules using an ex vivo lung phantom: influence of exposure parameters and iterative reconstruction.

    Science.gov (United States)

    Wielpütz, Mark O; Wroblewski, Jacek; Lederlin, Mathieu; Dinkel, Julien; Eichinger, Monika; Koenigkam-Santos, M; Biederer, Jürgen; Kauczor, Hans-Ulrich; Puderbach, Michael U; Jobst, Bertram J

    2015-05-01

    To evaluate the influence of exposure parameters and raw-data based iterative reconstruction (IR) on the performance of computer-aided detection (CAD) of pulmonary nodules on chest multidetector computed tomography (MDCT). Seven porcine lung explants were inflated in a dedicated ex vivo phantom shell and prepared with n=162 artificial nodules of a clinically relevant volume and maximum diameter (46-1063 μl, and 6.2-21.5 mm). n=118 nodules were solid and n=44 part-solid. MDCT was performed with different combinations of 120 and 80 kV with 120, 60, 30 and 12 mA*s, and reconstructed with both filtered back projection (FBP) and IR. Subsequently, 16 datasets per lung were subjected to dedicated CAD software. The rate of true positive, false negative and false positive CAD marks was measured for each reconstruction. The rate of true positive findings ranged between 88.9-91.4% for FBP and 88.3-90.1% for IR (n.s.) with most exposure settings, but was significantly lower with the combination of 80 kV and 12 mA*s (80.9% and 81.5%, respectively, pvolumes 300 μl (p<0.05). Similarly, it was significantly lower for diameters <12 mm compared to ≥12 mm (p<0.05). The rate of true positives for solid and part-solid nodules was similar. Nodule CAD on chest MDCT is robust over a wide range of exposure settings. Noise reduction by IR is not detrimental for CAD, and may be used to improve image quality in the setting of low-dose MDCT for lung cancer screening. Copyright © 2015 Elsevier Ireland Ltd. All rights reserved.

  16. Detection of small pulmonary nodules on chest radiographs: efficacy of dual-energy subtraction technique using flat-panel detector chest radiography

    International Nuclear Information System (INIS)

    Oda, S.; Awai, K.; Funama, Y.; Utsunomiya, D.; Yanaga, Y.; Kawanaka, K.; Nakaura, T.; Hirai, T.; Murakami, R.; Nomori, H.; Yamashita, Y.

    2010-01-01

    Aim: To investigate the effect of a double-exposure dual-energy subtraction (DES) technique on the diagnostic performance of radiologists detecting small pulmonary nodules on flat-panel detector (FPD) chest radiographs. Materials and methods: Using FPD radiography 41 sets of chest radiographs were obtained from 26 patients with pulmonary nodules measuring ≤20 mm and from 15 normal participants. Each dataset included standard and corresponding DES images. There were six non-solid, 10 part-solid, and 10 solid nodules. The mean size of the 26 nodules was 15 ± 4.8 mm. Receiver operating characteristic (ROC) analysis was performed to compare the performance of the eight board-certified radiologists. Results: For the eight radiologists, the mean value of the area under the ROC curve (AUC) without and with DES images was 0.62 ± 0.05 and 0.68 ± 0.05, respectively; the difference was statistically significant (p = 0.02). For part-solid nodules, the difference of the mean AUC value was statistically significant (AUC = 0.61 ± 0.07 versus 0.69 ± 0.05; p < 0.01); for non-solid nodules it was not (AUC = 0.62 ± 0.1 versus 0.61 ± 0.09; p = 0.73), and for solid nodules it was not (AUC = 0.75 ± 0.1 versus 0.78 ± 0.08; p = 0.23). For nodules with overlapping bone shadows, the difference of the mean AUC value was statistically significant (p = 0.03), for nodules without overlapping, it was not (p = 0.26). Conclusion: Use of a double-exposure DES technique at FPD chest radiography significantly improved the diagnostic performance of radiologists to detect small pulmonary nodules.

  17. Nodule management protocol of the NELSON randomised lung cancer screening trial

    NARCIS (Netherlands)

    Xu, Dong Ming; Gietema, Hester; de Koning, Harry; Vernhout, Rene; Nackaerts, Kristiaan; Prokop, Mathias; Weenink, Carla; Lammers, Jan-Willem; Groen, Harry; Oudkerk, Matthijs; van Klaveren, Rob

    In December 2003, the Dutch-Belgian NELSON trial, a Dutch acronym for "Nederlands-Leuvens Longkanker Screenings ONderzoek", has been launched. Primary objective of the NELSON trial is to investigate whether screening for lung cancer by 16-detector multi-slice CT with 16 mm x 0.75 mm collimation and

  18. small cell lung cancer in a Chinese population

    African Journals Online (AJOL)

    clinical significance in patients with non-small cell lung cancer (NSCLC) in Hubei province ... diagnosis, tumor stage, treatment, progression .... Table 4: Association between EGFR mutation, gender and histologic type in 138 NSCLC patients.

  19. Computer-aided diagnostic scheme for the detection of lung nodules on chest radiographs: Localized search method based on anatomical classification

    International Nuclear Information System (INIS)

    Shiraishi, Junji; Li Qiang; Suzuki, Kenji; Engelmann, Roger; Doi, Kunio

    2006-01-01

    We developed an advanced computer-aided diagnostic (CAD) scheme for the detection of various types of lung nodules on chest radiographs intended for implementation in clinical situations. We used 924 digitized chest images (992 noncalcified nodules) which had a 500x500 matrix size with a 1024 gray scale. The images were divided randomly into two sets which were used for training and testing of the computerized scheme. In this scheme, the lung field was first segmented by use of a ribcage detection technique, and then a large search area (448x448 matrix size) within the chest image was automatically determined by taking into account the locations of a midline and a top edge of the segmented ribcage. In order to detect lung nodule candidates based on a localized search method, we divided the entire search area into 7x7 regions of interest (ROIs: 64x64 matrix size). In the next step, each ROI was classified anatomically into apical, peripheral, hilar, and diaphragm/heart regions by use of its image features. Identification of lung nodule candidates and extraction of image features were applied for each localized region (128x128 matrix size), each having its central part (64x64 matrix size) located at a position corresponding to a ROI that was classified anatomically in the previous step. Initial candidates were identified by use of the nodule-enhanced image obtained with the average radial-gradient filtering technique, in which the filter size was varied adaptively depending on the location and the anatomical classification of the ROI. We extracted 57 image features from the original and nodule-enhanced images based on geometric, gray-level, background structure, and edge-gradient features. In addition, 14 image features were obtained from the corresponding locations in the contralateral subtraction image. A total of 71 image features were employed for three sequential artificial neural networks (ANNs) in order to reduce the number of false-positive candidates. All

  20. Optimal dose levels in screening chest CT for unimpaired detection and volumetry of lung nodules, with and without computer assisted detection at minimal patient radiation.

    Directory of Open Access Journals (Sweden)

    Andreas Christe

    Full Text Available OBJECTIVES: The aim of this phantom study was to minimize the radiation dose by finding the best combination of low tube current and low voltage that would result in accurate volume measurements when compared to standard CT imaging without significantly decreasing the sensitivity of detecting lung nodules both with and without the assistance of CAD. METHODS: An anthropomorphic chest phantom containing artificial solid and ground glass nodules (GGNs, 5-12 mm was examined with a 64-row multi-detector CT scanner with three tube currents of 100, 50 and 25 mAs in combination with three tube voltages of 120, 100 and 80 kVp. This resulted in eight different protocols that were then compared to standard CT sensitivity (100 mAs/120 kVp. For each protocol, at least 127 different nodules were scanned in 21-25 phantoms. The nodules were analyzed in two separate sessions by three independent, blinded radiologists and computer-aided detection (CAD software. RESULTS: The mean sensitivity of the radiologists for identifying solid lung nodules on a standard CT was 89.7% ± 4.9%. The sensitivity was not significantly impaired when the tube and current voltage were lowered at the same time, except at the lowest exposure level of 25 mAs/80 kVp [80.6% ± 4.3% (p = 0.031]. Compared to the standard CT, the sensitivity for detecting GGNs was significantly lower at all dose levels when the voltage was 80 kVp; this result was independent of the tube current. The CAD significantly increased the radiologists' sensitivity for detecting solid nodules at all dose levels (5-11%. No significant volume measurement errors (VMEs were documented for the radiologists or the CAD software at any dose level. CONCLUSIONS: Our results suggest a CT protocol with 25 mAs and 100 kVp is optimal for detecting solid and ground glass nodules in lung cancer screening. The use of CAD software is highly recommended at all dose levels.

  1. 3D Convolutional Neural Network for Automatic Detection of Lung Nodules in Chest CT.

    Science.gov (United States)

    Hamidian, Sardar; Sahiner, Berkman; Petrick, Nicholas; Pezeshk, Aria

    2017-01-01

    Deep convolutional neural networks (CNNs) form the backbone of many state-of-the-art computer vision systems for classification and segmentation of 2D images. The same principles and architectures can be extended to three dimensions to obtain 3D CNNs that are suitable for volumetric data such as CT scans. In this work, we train a 3D CNN for automatic detection of pulmonary nodules in chest CT images using volumes of interest extracted from the LIDC dataset. We then convert the 3D CNN which has a fixed field of view to a 3D fully convolutional network (FCN) which can generate the score map for the entire volume efficiently in a single pass. Compared to the sliding window approach for applying a CNN across the entire input volume, the FCN leads to a nearly 800-fold speed-up, and thereby fast generation of output scores for a single case. This screening FCN is used to generate difficult negative examples that are used to train a new discriminant CNN. The overall system consists of the screening FCN for fast generation of candidate regions of interest, followed by the discrimination CNN.

  2. Development of a Blood-Based Biomarker Panel for Indeterminate Lung Nodules

    Science.gov (United States)

    2016-09-01

    based markers are a promising and attractive approach to complement LDCT because of the potential to identify those subjects that need to undergo further...concerns including high false positivity, cost, and radiation exposure. Blood- based markers are a promising and attractive approach to complement...innovations, successes, or any change in practice or behavior that has come about as a result of the project Although a large number of lung cancer biomarker

  3. A 3-D Riesz-Covariance Texture Model for Prediction of Nodule Recurrence in Lung CT

    OpenAIRE

    Cirujeda Pol; Dicente Cid Yashin; Müller Henning; Rubin Daniel L.; Aguilera Todd A.; Jr. Billy W. Loo; Diehn Maximilian; Binefa Xavier; Depeursinge Adrien

    2016-01-01

    This paper proposes a novel imaging biomarker of lung cancer relapse from 3 D texture analysis of CT images. Three dimensional morphological nodular tissue properties are described in terms of 3 D Riesz wavelets. The responses of the latter are aggregated within nodular regions by means of feature covariances which leverage rich intra and inter variations of the feature space dimensions. When compared to the classical use of the average for feature aggregation feature covariances preserve sp...

  4. Performance of computer-aided detection of pulmonary nodules in low-dose CT: comparison with double reading by nodule volume

    Energy Technology Data Exchange (ETDEWEB)

    Zhao, Yingru; Vliegenthart, Rozemarijn; Wang, Ying; Ooijen, Peter M.A. van; Oudkerk, Matthijs [University of Groningen/University Medical Center Groningen, Center for Medical Imaging - North East Netherlands, Department of Radiology, P.O. Box 30.001, Groningen (Netherlands); Bock, Geertruida H. de [University of Groningen/University Medical Center Groningen, Department of Epidemiology, P.O. Box 30.001, Groningen (Netherlands); Klaveren, Rob J. van [Lievensberg Hospital, Department of Pulmonology, P.O. Box 135, Bergen op Zoom (Netherlands); Bogoni, Luca [CAD Group, Siemens Medical Solutions USA, Inc., Malvern, PA (United States); Jong, Pim A. de; Mali, Willem P. [University of Utrecht, Department of Radiology, University Medical Center Utrecht, P.O. Box 85500, Utrecht (Netherlands)

    2012-10-15

    To evaluate performance of computer-aided detection (CAD) beyond double reading for pulmonary nodules on low-dose computed tomography (CT) by nodule volume. A total of 400 low-dose chest CT examinations were randomly selected from the NELSON lung cancer screening trial. CTs were evaluated by two independent readers and processed by CAD. A total of 1,667 findings marked by readers and/or CAD were evaluated by a consensus panel of expert chest radiologists. Performance was evaluated by calculating sensitivity of pulmonary nodule detection and number of false positives, by nodule characteristics and volume. According to the screening protocol, 90.9 % of the findings could be excluded from further evaluation, 49.2 % being small nodules (less than 50 mm{sup 3}). Excluding small nodules reduced false-positive detections by CAD from 3.7 to 1.9 per examination. Of 151 findings that needed further evaluation, 33 (21.9 %) were detected by CAD only, one of them being diagnosed as lung cancer the following year. The sensitivity of nodule detection was 78.1 % for double reading and 96.7 % for CAD. A total of 69.7 % of nodules undetected by readers were attached nodules of which 78.3 % were vessel-attached. CAD is valuable in lung cancer screening to improve sensitivity of pulmonary nodule detection beyond double reading, at a low false-positive rate when excluding small nodules. circle Computer-aided detection (CAD) has known advantages for computed tomography (CT). (orig.)

  5. Performance of computer-aided detection of pulmonary nodules in low-dose CT: comparison with double reading by nodule volume

    International Nuclear Information System (INIS)

    Zhao, Yingru; Vliegenthart, Rozemarijn; Wang, Ying; Ooijen, Peter M.A. van; Oudkerk, Matthijs; Bock, Geertruida H. de; Klaveren, Rob J. van; Bogoni, Luca; Jong, Pim A. de; Mali, Willem P.

    2012-01-01

    To evaluate performance of computer-aided detection (CAD) beyond double reading for pulmonary nodules on low-dose computed tomography (CT) by nodule volume. A total of 400 low-dose chest CT examinations were randomly selected from the NELSON lung cancer screening trial. CTs were evaluated by two independent readers and processed by CAD. A total of 1,667 findings marked by readers and/or CAD were evaluated by a consensus panel of expert chest radiologists. Performance was evaluated by calculating sensitivity of pulmonary nodule detection and number of false positives, by nodule characteristics and volume. According to the screening protocol, 90.9 % of the findings could be excluded from further evaluation, 49.2 % being small nodules (less than 50 mm 3 ). Excluding small nodules reduced false-positive detections by CAD from 3.7 to 1.9 per examination. Of 151 findings that needed further evaluation, 33 (21.9 %) were detected by CAD only, one of them being diagnosed as lung cancer the following year. The sensitivity of nodule detection was 78.1 % for double reading and 96.7 % for CAD. A total of 69.7 % of nodules undetected by readers were attached nodules of which 78.3 % were vessel-attached. CAD is valuable in lung cancer screening to improve sensitivity of pulmonary nodule detection beyond double reading, at a low false-positive rate when excluding small nodules. circle Computer-aided detection (CAD) has known advantages for computed tomography (CT). (orig.)

  6. Clinical Application of 18F-FDG PET in Non-Small Cell Lung Cancer

    International Nuclear Information System (INIS)

    Choi, Joon Young

    2008-01-01

    This review focuses on the clinical use of 18 F-FDG PET to evaluate solitary pulmonary nodule (SPN) and non-small cell lung cancer (NSCLC). When SPN or mass without calcification is found on chest X-ray or CT, 18 F-FDG PET is an effective modality to differentiate benign from malignant lesions. For initial staging of NSCLC, 18 F-FDG PET is useful, and proved to be cost-effective in several countries. 18 F-FDG PET is useful for detecting recurrence, restaging and evaluating residual tumor after curative therapy in NSCLC. For therapy response assessment, 18 F-FDG PET may be effective after chemotherapy or radiation therapy. 18 F-FDG PET is useful to predict pathological response after neoadjuvant therapy in NSCLC. For radiation therapy planning, 18 F-FDG PET may be helpful, but requires further investigations. PET/CT is better for evaluating NSCLC than conventional PET

  7. Spatial frequency characteristics at image decision-point locations for observers with different radiological backgrounds in lung nodule detection

    Science.gov (United States)

    Pietrzyk, Mariusz W.; Manning, David J.; Dix, Alan; Donovan, Tim

    2009-02-01

    Aim: The goal of the study is to determine the spatial frequency characteristics at locations in the image of overt and covert observers' decisions and find out if there are any similarities in different observers' groups: the same radiological experience group or the same accuracy scored level. Background: The radiological task is described as a visual searching decision making procedure involving visual perception and cognitive processing. Humans perceive the world through a number of spatial frequency channels, each sensitive to visual information carried by different spatial frequency ranges and orientations. Recent studies have shown that particular physical properties of local and global image-based elements are correlated with the performance and the level of experience of human observers in breast cancer and lung nodule detections. Neurological findings in visual perception were an inspiration for wavelet applications in vision research because the methodology tries to mimic the brain processing algorithms. Methods: The wavelet approach to the set of postero-anterior chest radiographs analysis has been used to characterize perceptual preferences observers with different levels of experience in the radiological task. Psychophysical methodology has been applied to track eye movements over the image, where particular ROIs related to the observers' fixation clusters has been analysed in the spaces frame by Daubechies functions. Results: Significance differences have been found between the spatial frequency characteristics at the location of different decisions.

  8. TH-AB-207A-09: Tailoring TCM Schemes to a Task: Evaluating the Impact of Customized TCM Profiles On Detection of Lung Nodules in Simulated CT Lung Cancer Screening

    Energy Technology Data Exchange (ETDEWEB)

    Hoffman, J; McNitt-Gray, M [Departments of Biomedical Physics and Radiology, David Geffen School of Medicine at UCLA, Los Angeles, CA (United States); Noo, F [University of Utah, Salt Lake City, UT (United States); Young, S [Department of Radiology, UCLA, Los Angeles, CA (United States)

    2016-06-15

    Purpose: Recent work has shown that current TCM profile designs boost detection of low-contrast lung lesions in the lung apices, but yield reduced detection performance in the mid and lower lung regions relative to fixed tube current cases. This observed imbalance suggests that the TCM scheme might be tailored in new ways to maximize nodule detection throughout the entire lung. In this work, we begin a preliminary investigation into custom TCM profiles in an attempt to achieve uniform lesion detection throughout the extent of the lung. Methods: Low-contrast (25HU), 6mm nodules representing ground glass opacities were simulated at 1mm intervals over the length the lungs in a voxelized model of the XCAT phantom, one nodule per lung, per simulated scan. Voxel values represented attenuation values at 80keV. CT projection data was created by simulating a finite focal spot and using Joseph’s method for forward projection; scanner geometry was that of the Siemens Sensation 64 and the X-ray source was simulated as an 80keV monochromatic beam. Noise realizations were created using Poisson statistics, a realistic bowtie filter and varying tube current. 500 noise realizations were created for the custom TCM designs. All reconstruction was done with FreeCT-wFBP. An SKE/BKE task was used in conjunction with a 2D Hotelling Observer to calculate area-under-the-curve (AUC) as a proxy for “detectability.” AUC was plotted as a function of nodule Z-location to create a “detectability map.” The detectability map for the custom TCM curve was qualitatively assessed relative to previous results for the fixed TC and clinical TCM cases for uniformity. Results: Detection uniformity was improved throughout the mid and lower lungs, however detection remained disproportionately high in the upper lung region. Conclusion: Detection uniformity was improved with a custom TC profile. Future work will incorporate an analytic, task-specific approach to optimize the TC scheme for nodule

  9. TH-AB-207A-09: Tailoring TCM Schemes to a Task: Evaluating the Impact of Customized TCM Profiles On Detection of Lung Nodules in Simulated CT Lung Cancer Screening

    International Nuclear Information System (INIS)

    Hoffman, J; McNitt-Gray, M; Noo, F; Young, S

    2016-01-01

    Purpose: Recent work has shown that current TCM profile designs boost detection of low-contrast lung lesions in the lung apices, but yield reduced detection performance in the mid and lower lung regions relative to fixed tube current cases. This observed imbalance suggests that the TCM scheme might be tailored in new ways to maximize nodule detection throughout the entire lung. In this work, we begin a preliminary investigation into custom TCM profiles in an attempt to achieve uniform lesion detection throughout the extent of the lung. Methods: Low-contrast (25HU), 6mm nodules representing ground glass opacities were simulated at 1mm intervals over the length the lungs in a voxelized model of the XCAT phantom, one nodule per lung, per simulated scan. Voxel values represented attenuation values at 80keV. CT projection data was created by simulating a finite focal spot and using Joseph’s method for forward projection; scanner geometry was that of the Siemens Sensation 64 and the X-ray source was simulated as an 80keV monochromatic beam. Noise realizations were created using Poisson statistics, a realistic bowtie filter and varying tube current. 500 noise realizations were created for the custom TCM designs. All reconstruction was done with FreeCT_wFBP. An SKE/BKE task was used in conjunction with a 2D Hotelling Observer to calculate area-under-the-curve (AUC) as a proxy for “detectability.” AUC was plotted as a function of nodule Z-location to create a “detectability map.” The detectability map for the custom TCM curve was qualitatively assessed relative to previous results for the fixed TC and clinical TCM cases for uniformity. Results: Detection uniformity was improved throughout the mid and lower lungs, however detection remained disproportionately high in the upper lung region. Conclusion: Detection uniformity was improved with a custom TC profile. Future work will incorporate an analytic, task-specific approach to optimize the TC scheme for nodule

  10. Respiratory-Gated Helical Computed Tomography of Lung: Reproducibility of Small Volumes in an Ex Vivo Model

    International Nuclear Information System (INIS)

    Biederer, Juergen; Dinkel, Julien; Bolte, Hendrik; Welzel, Thomas; Hoffmann, Beata M.Sc.; Thierfelder, Carsten; Mende, Ulrich; Debus, Juergen; Heller, Martin; Kauczor, Hans-Ulrich

    2007-01-01

    Purpose: Motion-adapted radiotherapy with gated irradiation or tracking of tumor positions requires dedicated imaging techniques such as four-dimensional (4D) helical computed tomography (CT) for patient selection and treatment planning. The objective was to evaluate the reproducibility of spatial information for small objects on respiratory-gated 4D helical CT using computer-assisted volumetry of lung nodules in a ventilated ex vivo system. Methods and Materials: Five porcine lungs were inflated inside a chest phantom and prepared with 55 artificial nodules (mean diameter, 8.4 mm ± 1.8). The lungs were respirated by a flexible diaphragm and scanned with 40-row detector CT (collimation, 24 x 1.2 mm; pitch, 0.1; rotation time, 1 s; slice thickness, 1.5 mm; increment, 0.8 mm). The 4D-CT scans acquired during respiration (eight per minute) and reconstructed at 0-100% inspiration and equivalent static scans were scored for motion-related artifacts (0 or absent to 3 or relevant). The reproducibility of nodule volumetry (three readers) was assessed using the variation coefficient (VC). Results: The mean volumes from the static and dynamic inspiratory scans were equal (364.9 and 360.8 mm 3 , respectively, p = 0.24). The static and dynamic end-expiratory volumes were slightly greater (371.9 and 369.7 mm 3 , respectively, p = 0.019). The VC for volumetry (static) was 3.1%, with no significant difference between 20 apical and 20 caudal nodules (2.6% and 3.5%, p = 0.25). In dynamic scans, the VC was greater (3.9%, p = 0.004; apical and caudal, 2.6% and 4.9%; p = 0.004), with a significant difference between static and dynamic in the 20 caudal nodules (3.5% and 4.9%, p = 0.015). This was consistent with greater motion-related artifacts and image noise at the diaphragm (p <0.05). The VC for interobserver variability was 0.6%. Conclusion: Residual motion-related artifacts had only minimal influence on volumetry of small solid lesions. This indicates a high reproducibility of

  11. Development of a multivariate model to predict the likelihood of carcinoma in patients with indeterminate peripheral lung nodules after a nondiagnostic bronchoscopic evaluation.

    Science.gov (United States)

    Voss, Jesse S; Iqbal, Seher; Jenkins, Sarah M; Henry, Michael R; Clayton, Amy C; Jett, James R; Kipp, Benjamin R; Halling, Kevin C; Maldonado, Fabien

    2014-01-01

    Studies have shown that fluorescence in situ hybridization (FISH) testing increases lung cancer detection on cytology specimens in peripheral nodules. The goal of this study was to determine whether a predictive model using clinical features and routine cytology with FISH results could predict lung malignancy after a nondiagnostic bronchoscopic evaluation. Patients with an indeterminate peripheral lung nodule that had a nondiagnostic bronchoscopic evaluation were included in this study (N = 220). FISH was performed on residual bronchial brushing cytology specimens diagnosed as negative (n = 195), atypical (n = 16), or suspicious (n = 9). FISH results included hypertetrasomy (n = 30) and negative (n = 190). Primary study end points included lung cancer status along with time to diagnosis of lung cancer or date of last clinical follow-up. Hazard ratios (HRs) were calculated using Cox proportional hazards regression model analyses, and P values < .05 were considered statistically significant. The mean age of the 220 patients was 66.7 years (range, 35-91), and most (58%) were men. Most patients (79%) were current or former smokers with a mean pack year history of 43.2 years (median, 40; range, 1-200). After multivariate analysis, hypertetrasomy FISH (HR = 2.96, P < .001), pack years (HR = 1.03 per pack year up to 50, P = .001), age (HR = 1.04 per year, P = .02), atypical or suspicious cytology (HR = 2.02, P = .04), and nodule spiculation (HR = 2.36, P = .003) were independent predictors of malignancy over time and were used to create a prediction model (C-statistic = 0.78). These results suggest that this multivariate model including test results and clinical features may be useful following a nondiagnostic bronchoscopic examination. © 2013.

  12. Computed tomography of pulmonary nodules

    International Nuclear Information System (INIS)

    Nakata, Hajime; Honda, Hiroshi; Nakayama, Chikashi; Kimoto, Tatsuya; Nakayama, Takashi

    1983-01-01

    We have evaluated the value of computed tomography (CT) in distinguishing benign and malignant pulmonary nodules. CT was performed on 30 cases of solitary pulmonary nodules consisting of 17 primary lung cancers, 3 metastatic tumors and 10 benign nodules. The CT number was calculated for each lesion. Three benign nodules showed CT numbers well above the range of malignant nodules, and only in one of them was calcification visible on conventional tomography. In 6 benign nodules, the CT numbers overlapped those of malignant lesion and could not be differentiated. Thus the measurement of CT number can be useful to confirm the benign nature of certain nodules when calcification is unclear or not visible on conventional tomography. As for the morphological observation of the nodule, CT was not superior to conventional tomography and its value seems to be limited. (author)

  13. Benign pulmonary nodule. Morphological features and contrast enhancement evaluated with contiguous thin-section CT

    Energy Technology Data Exchange (ETDEWEB)

    Matsuo, Hisayasu; Murata, Kiyoshi; Takahashi, Masashi; Morita, Rikushi [Shiga Univ. of Medical Science, Otsu (Japan)

    1998-10-01

    The morphological changes in 54 benign lung nodules, including 8 histologically proven nodules of tuberculoma, 10 of focal organizing pneumonia (FOP), 1 of lung abscess and 35 other benign nodules, were evaluated with contiguous thin-section (3 mm) CT. In addition, incremental dynamic studies were carried out in 25 of these nodules. The three-dimensional shapes of the nodules were found to be quite varied and were classified into four types: round mass (n=18), polygonal mass with concave or straight margins (n=20), oval or band-like mass extending along the bronchovascular bundle (n=7), and oval mass attached to the pleura with broad contact (n=9). Forty-two (78%) of the 54 nodules were located along the bronchovascular bundle. The maximum increments in CT values over 20 HU were observed after contrast enhancement in 18 (72%) of the 25 benign nodules, among which all tuberculomas showed little or no contrast enhancement. The number of small vessels quantified microscopically in the center of the nodules were minimal in tuberculomas with little enhancement and plentiful in lesions of FOP and abscess which showed marked enhancement. Our results suggest that the differentiation between benign and malignant pulmonary nodules is not possible simply on the basis of the degree of contrast enhancement. Therefore, morphological features and the anatomical relation to the bronchovascular bundles should also be taken into consideration in the diagnosis of pulmonary nodules. (author)

  14. Benign pulmonary nodule. Morphological features and contrast enhancement evaluated with contiguous thin-section CT

    International Nuclear Information System (INIS)

    Matsuo, Hisayasu; Murata, Kiyoshi; Takahashi, Masashi; Morita, Rikushi

    1998-01-01

    The morphological changes in 54 benign lung nodules, including 8 histologically proven nodules of tuberculoma, 10 of focal organizing pneumonia (FOP), 1 of lung abscess and 35 other benign nodules, were evaluated with contiguous thin-section (3 mm) CT. In addition, incremental dynamic studies were carried out in 25 of these nodules. The three-dimensional shapes of the nodules were found to be quite varied and were classified into four types: round mass (n=18), polygonal mass with concave or straight margins (n=20), oval or band-like mass extending along the bronchovascular bundle (n=7), and oval mass attached to the pleura with broad contact (n=9). Forty-two (78%) of the 54 nodules were located along the bronchovascular bundle. The maximum increments in CT values over 20 HU were observed after contrast enhancement in 18 (72%) of the 25 benign nodules, among which all tuberculomas showed little or no contrast enhancement. The number of small vessels quantified microscopically in the center of the nodules were minimal in tuberculomas with little enhancement and plentiful in lesions of FOP and abscess which showed marked enhancement. Our results suggest that the differentiation between benign and malignant pulmonary nodules is not possible simply on the basis of the degree of contrast enhancement. Therefore, morphological features and the anatomical relation to the bronchovascular bundles should also be taken into consideration in the diagnosis of pulmonary nodules. (author)

  15. Comparison of chest radiography, chest digital tomosynthesis and low dose MDCT to detect small ground-glass opacity nodules: an anthropomorphic chest phantom study

    International Nuclear Information System (INIS)

    Doo, Kyung Won; Kang, Eun-Young; Yong, Hwan Seok; Ham, Soo-Youn; Lee, Ki Yeol; Choo, Ji Yung

    2014-01-01

    The purpose of this study was to evaluate the diagnostic performance of chest radiography (CXR), chest digital tomosynthesis (DT) and low dose multidetector computed tomography (LDCT) for the detection of small pulmonary ground-glass opacity (GGO) nodules, using an anthropomorphic chest phantom. Artificial pulmonary nodules were placed in a phantom and a total of 40 samples of different nodule settings underwent CXR, DT and LDCT. The images were randomly read by three experienced chest radiologists. Free-response receiver-operating characteristics (FROC) were used. The figures of merit for the FROC curves averaged for the three observers were 0.41, 0.37 and 0.76 for CXR, DT and LDCT, respectively. FROC analyses revealed significantly better performance of LDCT over CXR or DT for the detection of GGO nodules (P < 0.05). The difference in detectability between CXR and DT was not statistically significant (P = 0.73). The diagnostic performance of DT for the detection of pulmonary small GGO nodules was not significantly different from that of CXR, but LDCT performed significantly better than both CXR and DT. DT is not a suitable alternative to CT for small GGO nodule detection, and LDCT remains the method of choice for this purpose. (orig.)

  16. Comparison of chest radiography, chest digital tomosynthesis and low dose MDCT to detect small ground-glass opacity nodules: an anthropomorphic chest phantom study

    Energy Technology Data Exchange (ETDEWEB)

    Doo, Kyung Won; Kang, Eun-Young; Yong, Hwan Seok [Korea University Guro Hospital, Korea University College of Medicine, Department of Radiology, Seoul (Korea, Republic of); Ham, Soo-Youn [Korea University Anam Hospital, Korea University College of Medicine, Department of Radiology, Seoul (Korea, Republic of); Lee, Ki Yeol; Choo, Ji Yung [Korea University Ansan Hospital, Korea University College of Medicine, Department of Radiology, Ansan (Korea, Republic of)

    2014-12-15

    The purpose of this study was to evaluate the diagnostic performance of chest radiography (CXR), chest digital tomosynthesis (DT) and low dose multidetector computed tomography (LDCT) for the detection of small pulmonary ground-glass opacity (GGO) nodules, using an anthropomorphic chest phantom. Artificial pulmonary nodules were placed in a phantom and a total of 40 samples of different nodule settings underwent CXR, DT and LDCT. The images were randomly read by three experienced chest radiologists. Free-response receiver-operating characteristics (FROC) were used. The figures of merit for the FROC curves averaged for the three observers were 0.41, 0.37 and 0.76 for CXR, DT and LDCT, respectively. FROC analyses revealed significantly better performance of LDCT over CXR or DT for the detection of GGO nodules (P < 0.05). The difference in detectability between CXR and DT was not statistically significant (P = 0.73). The diagnostic performance of DT for the detection of pulmonary small GGO nodules was not significantly different from that of CXR, but LDCT performed significantly better than both CXR and DT. DT is not a suitable alternative to CT for small GGO nodule detection, and LDCT remains the method of choice for this purpose. (orig.)

  17. The value of FDG-PET/CT in assessing single pulmonary nodules in patients at high risk of lung cancer

    International Nuclear Information System (INIS)

    Kagna, Olga; Solomonov, Anna; Fruchter, Oren; Keidar, Zohar; Bar-Shalom, Rachel; Israel, Ora; Yigla, Mordechai; Guralnik, Luda

    2009-01-01

    To evaluate whether PET/low-dose CT (ldCT) using 18 F-fluorodeoxyglucose (FDG) improves characterization of indeterminate single pulmonary nodules (SPNs) in patients at high risk of lung cancer. Retrospective analysis of 307 patients who underwent FDG-PET/CT for indeterminate SPNs identified 93 (70 men, age range 46-90 years) at high risk of lung cancer (age >40 years, minimum 10 pack-year smokers). SPNs were evaluated for the presence and intensity of FDG avidity and ldCT patterns. The performance of visual and semiquantitative FDG-PET/ldCT algorithms for characterization of SPNs was compared to that of ldCT. Incongruent FDG-PET and ldCT patterns were analyzed for significance in further patient management. Malignancy was diagnosed in 38% patients. FDG avidity defined 33 SPNs as true-positive (TP) and 2 as false-negative (FN) (malignant), and 41 as true-negative (TN) and 17 as false-positive (FP) (benign). For SUVmax of 2.2 (by ROC analysis) there were 27 TP, 8 FN, 48 TN and 10 FP SPNs. LdCT defined 34 TP, 1 FN, 28 TN and 30 FP lesions. Of the FP lesions on ldCT, 60% were FDG-negative. Visual PET/ldCT analysis had a sensitivity of 94%, a specificity of 70%, an accuracy of 80%, a positive predictive value (PPV) of 66%, and a negative predictive value (NPV) of 95% as compared to 77%, 83%, 81%, 73%, 86% for semiquantitative PET/ldCT and 97%, 48%, 66%, 53%, 96% for ldCT, respectively. Both PET/ldCT algorithms had statistically significantly higher specificity and accuracy than ldCT. Semiquantitative analysis showed significantly higher PPV and lower sensitivity and NPV than found with ldCT. A single screening procedure encompassing FDG-PET and ldCT may improve screening for lung cancer in high-risk patients. The significantly improved specificity may potentially reduce FP ldCT results and further unnecessary invasive procedures. (orig.)

  18. Predicting adenocarcinoma recurrence using computational texture models of nodule components in lung CT

    International Nuclear Information System (INIS)

    Depeursinge, Adrien; Yanagawa, Masahiro; Leung, Ann N.; Rubin, Daniel L.

    2015-01-01

    Purpose: To investigate the importance of presurgical computed tomography (CT) intensity and texture information from ground-glass opacities (GGO) and solid nodule components for the prediction of adenocarcinoma recurrence. Methods: For this study, 101 patients with surgically resected stage I adenocarcinoma were selected. During the follow-up period, 17 patients had disease recurrence with six associated cancer-related deaths. GGO and solid tumor components were delineated on presurgical CT scans by a radiologist. Computational texture models of GGO and solid regions were built using linear combinations of steerable Riesz wavelets learned with linear support vector machines (SVMs). Unlike other traditional texture attributes, the proposed texture models are designed to encode local image scales and directions that are specific to GGO and solid tissue. The responses of the locally steered models were used as texture attributes and compared to the responses of unaligned Riesz wavelets. The texture attributes were combined with CT intensities to predict tumor recurrence and patient hazard according to disease-free survival (DFS) time. Two families of predictive models were compared: LASSO and SVMs, and their survival counterparts: Cox-LASSO and survival SVMs. Results: The best-performing predictive model of patient hazard was associated with a concordance index (C-index) of 0.81 ± 0.02 and was based on the combination of the steered models and CT intensities with survival SVMs. The same feature group and the LASSO model yielded the highest area under the receiver operating characteristic curve (AUC) of 0.8 ± 0.01 for predicting tumor recurrence, although no statistically significant difference was found when compared to using intensity features solely. For all models, the performance was found to be significantly higher when image attributes were based on the solid components solely versus using the entire tumors (p < 3.08 × 10 −5 ). Conclusions: This study

  19. Computer-assisted solid lung nodule 3D volumetry on CT. Influence of scan mode and iterative reconstruction. A CT phantom study

    International Nuclear Information System (INIS)

    Coenen, Adriaan; Honda, Osamu; Tomiyama, Noriyuki; Jagt, Eric J. van der

    2013-01-01

    The objective of this study was to evaluate the effect of high-resolution scan mode and iterative reconstruction on lung nodule 3D volumetry. Solid nodules with various sizes (5, 8, 10 and 12 mm) were placed inside a chest phantom. CT images were obtained with various tube currents, scan modes (conventional mode, high-resolution mode) and iterative reconstructions [0, 50 and 100% blending of adaptive statistical iterative reconstruction (ASiR) and filtered back projection]. The nodule volumes were calculated using semiautomatic software and compared with the assumed volume from the nodules. The mean absolute and relative percentage error improved when using iterative reconstruction especially when using the conventional scan mode; however, this effect was not significant. Significant reduction in volume overestimation was observed when using high-resolution scan mode (P=0.011). The high-resolution mode significantly reduces the volume overestimation of 3D volumetry. Iterative reconstruction shows a reduction in volume overestimation and error margin especially with the conventional scan mode; however, this effect was not significant. (author)

  20. Tracking the Evolution of Non-Small-Cell Lung Cancer

    DEFF Research Database (Denmark)

    Jamal-Hanjani, Mariam; Wilson, Gareth A.; McGranahan, Nicholas

    2017-01-01

    Background Among patients with non-small-cell lung cancer (NSCLC), data on intratumor heterogeneity and cancer genome evolution have been limited to small retrospective cohorts. We wanted to prospectively investigate intratumor heterogeneity in relation to clinical outcome and to determine...... as a prognostic predictor. (Funded by Cancer Research UK and others; TRACERx ClinicalTrials.gov number, NCT01888601 .)....

  1. 1st ESMO Consensus Conference in lung cancer; Lugano 2010: small-cell lung cancer

    DEFF Research Database (Denmark)

    Stahel, R; Thatcher, N; Früh, M

    2011-01-01

    , the expert panel prepared clinically relevant questions concerning five areas as follows: early and locally advanced non-small-cell lung cancer (NSCLC), first-line metastatic NSCLC, second-/third-line NSCLC, NSCLC pathology and molecular testing, and small-cell lung cancer (SCLC) to be addressed through......The 1st ESMO Consensus Conference on lung cancer was held in Lugano, Switzerland on 21st and 22nd May 2010 with the participation of a multidisciplinary panel of leading professionals in pathology and molecular diagnostics and medical, surgical and radiation oncology. Before the conference...

  2. 1st ESMO Consensus Conference in lung cancer; Lugano 2010: small-cell lung cancer

    DEFF Research Database (Denmark)

    Stahel, R; Thatcher, N; Früh, M

    2011-01-01

    The 1st ESMO Consensus Conference on lung cancer was held in Lugano, Switzerland on 21st and 22nd May 2010 with the participation of a multidisciplinary panel of leading professionals in pathology and molecular diagnostics and medical, surgical and radiation oncology. Before the conference......, the expert panel prepared clinically relevant questions concerning five areas as follows: early and locally advanced non-small-cell lung cancer (NSCLC), first-line metastatic NSCLC, second-/third-line NSCLC, NSCLC pathology and molecular testing, and small-cell lung cancer (SCLC) to be addressed through...

  3. An analysis of peripheral small lung carcinomas less than 20 mm in diameter in non-adenocarcinomas and carcinoids. Computed tomographic findings based on radiologic-pathologic correlation

    International Nuclear Information System (INIS)

    Tanaka, Gaku; Yamada, Kouzo; Oshita, Fumihiro; Nomura, Ikuo; Noda, Kazumasa; Nakayama, Haruhiko; Mitsuda, Aki; Kameda, Youichi; Yamakido, Michio

    2000-01-01

    With the introduction of computed tomography (CT) for chest screening in recent years, more cases of resected peripheral small lung carcinomas have been reported. Many of these were adenocarcinomas. To focus on CT findings of peripheral non-adenocarcinoma nodules, we performed a retrospective analysis based on radiographic-pathologic correlations. We analyzed CT findings based on the pathology of peripheral small lung carcinomas, excluding the histological type of adenocarcinomas. We compared our findings with those observed in adenocarcinomas. We reviewed 28 peripheral small lung carcinoma nodules less than 20 mm in diameter, including 13 squamous cell carcinomas, 4 small cell carcinomas, 2 adeno- squamous cell carcinomas, 1 large cell carcinoma, and 8 carcinoids. The carcinomas were classified into two different patterns; non-adenocarcinomas excluding carcinoids, and carcinoids. Both were solid-density types on high-resolution CT (HR-CT) images. The HR-CT findings regarding the shape and number of notching, and the presence or absence of ground glass opacity (GGO) were different between non-adenocarcinomas excluding carcinoids and adenocarcinomas. On the other hand, the HR-CT findings regarding spiculations, GGO and pleural indentations, and the absence of bronchial compression were different between carcinoids and adenocarcinomas. The shape characteristics and internal and marginal analysis on HR-CT images can contribute to the differential diagnosis of the histological type of peripheral small lung carcinomas. (author)

  4. Nodules size: An important factor in nodule mining?

    Digital Repository Service at National Institute of Oceanography (India)

    Valsangkar, A.B.

    A study of about 850 different sized nodules from 234 sites in the Central Indian Basin (CIB) showed a clear inverse relationship between size and grade of nodules. Among the different sized nodules, only the small (less than 2 cm) and medium (2...

  5. 'Dancing eyes, dancing feet syndrome' in small cell lung carcinoma.

    Science.gov (United States)

    Sharma, Chandramohan; Acharya, Mihir; Kumawat, Bansi Lal; Kochar, Abhishek

    2014-04-23

    A 60-year-old man presented with a 25-day history of acute onset instability of gait, tremulousness of limbs and involuntary eye movements. Examination revealed presence of opsoclonus, myoclonus and ataxia, without any loss of motor power in the limbs. Prompt investigations were directed towards identifying an underlying malignancy which is often associated with this type of clinical scenario. CT of the brain was normal and cerebrospinal fluid examination showed lymphocytic pleocytosis. A cavitatory lesion was found in the right lung base on the high-resolution CT of the chest and histopathological examination of this lung mass showed small cell lung carcinoma. The patient was managed symptomatically with levetiracetam and baclofen and referred to oncology department for resection of the lung mass.

  6. A case of squamous cell lung cancer after treating with radiation for small cell lung cancer

    International Nuclear Information System (INIS)

    Hayashi, Toshinari; Ide, Hiroshi; Siomi, Katsuhiko; Nakamura, Yukinobu; Tada, Shinya; Kageyama, Hiroshi; Kido, Masamitsu

    1999-01-01

    A 77-year-old man was admitted due to an abnormal shadow on a chest X-ray film in September 1993. Small cell lung cancer was diagnosed by transbronchial lung biopsy of left S 3 . Because of his pulmonary and renal dysfunction, he received only 40 Gy irradiation alone, and the tumor shadow disappeared. After 38 months' observation, a new nodular shadow was detected in the left upper lung field in March 1997. A tumor was found in left B 3 by bronchoscopy, and biopsy revealed squamous cell carcinoma. Because of his advanced age and hypoxia, he has had no active treatment. This was a rare case of small cell lung cancer with long term survival, treated only by radiation, in which a different histologic type of carcinoma appeared in the same radiation field. (author)

  7. Prognosis of small hepatocellular nodules detected only at the hepatobiliary phase of Gd-EOB-DTPA-enhanced MR imaging as hypointensity in cirrhosis or chronic hepatitis

    Energy Technology Data Exchange (ETDEWEB)

    Higaki, Atsushi; Ito, Katsuyoshi; Tamada, Tsutomu; Sone, Teruki; Kanki, Akihiko; Noda, Yasufumi; Yasokawa, Kazuya; Yamamoto, Akira [Kawasaki Medical School, Department of Radiology, Kurashiki City, Okayama (Japan)

    2014-10-15

    To evaluate the prognosis of ''strict'' high-risk nodules (small hepatocellular nodules detected only in the hepatobiliary phase of initial Gd-EOB-DTPA-enhanced MR examination) in patients with cirrhosis or chronic hepatitis. The study included thirty-three patients with 60 ''strict'' high-risk nodules showing hypointensity at the hepatobiliary phase that was undetectable at the vascular phase and other conventional sequences of initial Gd-EOB-DTPA-enhanced MR imaging. These nodules were observed on follow-up MR examinations until hypervascularity was detected. The potential predictive factors for hypervascular transformation were compared between two groups (group A showing hypervascular transformation, group B not showing hypervascularization). Ten (16.7 %) of 60 ''strict'' high-risk nodules showed hypervascular transformation during follow-up periods (group A). The growth rates of the nodules in group A (6.3 ± 4.5 mm/year) were significantly higher than those in group B (3.4 ± 7.2 mm/year) (p = 0.003). Additionally, the median observation period in group A (177.5 ± 189.5 day) was significantly shorter than in group B (419 ± 372.2 day) (p = 0.045). The other predictive factors were not significantly correlated with hypervascularization. Subsets of ''strict'' high-risk nodules showed hypervascular transformation during follow-up periods in association with increased growth rates, indicating that nodule growth rate is an important predictive factor for hypervascularization. (orig.)

  8. Additional effects of FDG-PET to thin-section CT for the differential diagnosis of lung nodules. A Japanese multicenter clinical study

    International Nuclear Information System (INIS)

    Kubota, Kazuo; Murakami, Koji; Inoue, Tomio; Saga, Tsuneo; Shiomi, Susumu

    2011-01-01

    This study was a controlled multicenter clinical study on patients with peripheral lung nodules to verify the improvement in the diagnostic ability of fluorodeoxyglucose-positron emission tomography (FDG-PET) when used in combination with thin-section CT (TS-CT). Patients with peripheral lung nodules (long maximal diameter: 10-30 mm) detected using CT were examined using TS-CT and FDG-PET for the differential diagnosis of benign or malignant lesions. The primary endpoint was the specificity of the results using a combination of TS-CT and FDG-PET, compared with the results for TS-CT alone. Images were interpreted by investigators at each institution. Blind readings were also performed by an independent image interpretation committee. The gold standard was a pathological diagnosis determined using a surgical or biopsy specimen obtained after PET; and the patients in whom a pathological diagnosis could not be obtained were diagnosed based on a follow-up TS-CT performed more than 6 months later. Adverse reactions to FDG were also evaluated. The blind reading results for 82 lesions in 81 subjects eligible for analysis among the 90 subjects included in the study showed a specificity of 91.2% (31/34) (95% confidence interval (CI): 76.3-98.1) for TS-CT + PET, compared with a specificity of 67.6% (23/34) (95% CI: 49.5-82.6) for TS-CT alone. The specificity was significantly improved by the addition of the PET findings (p<0.05). The sensitivity improved from 89.6% (43/48) for TS-CT to 91.7% (44/48) for TS-CT + PET; the addition of PET increased the level of confidence in the diagnosis, but the difference was not significant. The results reported by the institutional investigators were not significantly different. No serious adverse reactions occurred, although two of the 90 subjects exhibited mild adverse reactions. The addition of FDG-PET to TS-CT for the differential diagnosis of benign or malignant peripheral lung nodules resulted in a significant improvement in

  9. Detection of cytoskeletal proteins in small cell lung carcinoma

    Czech Academy of Sciences Publication Activity Database

    Hložánková, M.; Lukáš, Z.; Viklický, Vladimír

    1999-01-01

    Roč. 18, - (1999), s. 47-49 ISSN 0231-5882 Grant - others:MŠk1(CZ) OE10a/EU1450 Keywords : cytoskeletal proteins * small cell lung carcinoma Subject RIV: EI - Biotechnology ; Bionics Impact factor: 0.400, year: 1999

  10. Long-term survival in small-cell lung cancer

    DEFF Research Database (Denmark)

    Lassen, U; Osterlind, K; Hansen, M

    1995-01-01

    PURPOSE: To describe in patients with small-cell lung cancer (SCLC) the characteristics of those who survive for > or = 5 years, to identify long-term prognostic factors, to analyze survival data of 5-year survivors, and to study 10-year survival in patients entered before 1981. PATIENTS......, especially tobacco-related cancers and other tobacco-related diseases....

  11. Surgery in limited stage small cell lung cancer

    DEFF Research Database (Denmark)

    Lassen, U; Hansen, H H

    1999-01-01

    The role of surgery in small cell lung cancer (SCLC) is controversial. Surgery has several potential advantages because it may reduce the frequency of local relapses, it does not impede the intensity of chemotherapy, it does not affect the bone marrow, and surgical staging may be of prognostic...

  12. Cellular radiosensitivity of small-cell lung cancer cell lines

    DEFF Research Database (Denmark)

    Krarup, M; Poulsen, H S; Spang-Thomsen, M

    1997-01-01

    PURPOSE: The objective of this study was to determine the radiobiological characteristics of a panel of small-cell lung cancer (SCLC) cell lines by use of a clonogenic assay. In addition, we tested whether comparable results could be obtained by employing a growth extrapolation method based...

  13. Specifically targeted gene therapy for small-cell lung cancer

    DEFF Research Database (Denmark)

    Christensen, C.L.; Zandi, R.; Gjetting, T.

    2009-01-01

    Small-cell lung cancer (SCLC) is a highly malignant disease with poor prognosis. Hence, there is great demand for new therapies that can replace or supplement the current available treatment regimes. Gene therapy constitutes a promising strategy and relies on the principle of introducing exogenous...

  14. ORAL-THERAPY FOR SMALL-CELL LUNG-CANCER

    NARCIS (Netherlands)

    POSTMUS, PE; SMIT, EF

    After a remarkable improvement of the very poor prognosis of small cell lung cancer with very simple therapy such as iv and oral cyclophosphamide the role of oral therapy has become minimal. However, since more than a decade results of combination chemotherapy are at a plateau and it is necessary to

  15. Iris metastasis in small-cell lung carcinoma

    NARCIS (Netherlands)

    Roenhorst, Anke W. J.; van den Bergh, Alphons C. M.; van Putten, John W. G.; Smit, Egbert F.

    2007-01-01

    Small-cell lung cancer (SCLC) is characterized by rapid growth and early metastasis. Despite its sensitivity to cytotoxic treatment, until now treatments have failed to control or cure this disease in most patients. Here, we describe a patient with SCLC in which symptoms caused by iris metastasis

  16. Value of brain computed tomography in small cell lung cancers

    International Nuclear Information System (INIS)

    Fernet, M.; Breau, J.L.; Goldlust, D.; Israel, L.

    1988-01-01

    88 patients with small cell lung cancer were studied. Brain scans were performed first at initial staging and repeated at regular intervals during the survey. The results confirm the limited value of brain scans in the detection of metastases in neurologically asymptomatic patients [fr

  17. Dosimetric verification of small fields in the lung using lung-equivalent polymer gel and Monte Carlo simulation

    Directory of Open Access Journals (Sweden)

    Nahideh Gharehaghaji

    2018-01-01

    Conclusion: Our study showed that the dose reduction with small fields in the lung was very high. Thus, inaccurate prediction of absorbed dose inside the lung and also lung/soft-tissue interfaces with small photon beams may lead to critical consequences for treatment outcome.

  18. CT findings of small bowel metastases from primary lung cancer

    Energy Technology Data Exchange (ETDEWEB)

    Kim, Jae Wook; Ha, Hyun Kwon; Kim, Ah Young; Kim, Gab Choul; Kim, Tae Kyoung; Kim, Pyo Nyun; Lee, Moon Gyu [Ulsan University College of Medicine, Seoul (Korea, Republic of)

    2002-11-01

    To evaluate the CT findings of small bowel metastases from primary lung cancer. Of the 1468 patients with primary lung cancer between 1990 and 2000, 13 patients who had metastasis to the small intestine were collected. Of these 13 patients, nine who underwent CT scan were included for analysis. The pathologic diagnoses of primary lung cancer in these nine patients were squamous cell carcinoma in six, adenocarcinoma in two, and large cell carcinoma in one. CT scans were analyzed with regard to the site and patterns (intraluminal mass/bowel wall thickening/bowel implants) of metastatic masses, and the presence or absence of complication such as intussusception, obstruction, or perforation of the small bowel. The medical records of the patients were also reviewed retrospectively for evaluation of presenting abdominal symptom and time interval of metastases from initial diagnosis of lung cancer. Metastatic lesions were distributed throughout the small intestine: the duodenum in five, the jejunum in four, the ileum in six, and both jejunum and ileum in one patient. The size of metastatic masses of small bowel ranged from 1.3 cm to 5.0 cm (mean size, 2.6 cm) On CT, the small bowel was involved with intraluminal masses (mean size, 3.4 cm) in eight patients, diffuse wall thickening (mean thickness, 1.6 cm) in five, and bowel implants (mean size, 2.2 cm) in two. Complications occurred in seven patients, including intussusceptions without obstruction in two patients and with obstruction in two, obstruction without intussusceptions in two, and bowel perforation in one. Of 9 patients, 6 had at least one symptom referable to the small bowel including abdominal pain in 4, anemia in 3, vomiting in 1, and jaundice in 1. Lung cancer and small bowel lesions were detected simultaneously in four patients and the time interval of metastases from initial diagnosis of lung cancer ranged from 10 days to 30 months (median interval, 54 days) in patients. CT helps in defining the extent and

  19. CT findings of small bowel metastases from primary lung cancer

    International Nuclear Information System (INIS)

    Kim, Jae Wook; Ha, Hyun Kwon; Kim, Ah Young; Kim, Gab Choul; Kim, Tae Kyoung; Kim, Pyo Nyun; Lee, Moon Gyu

    2002-01-01

    To evaluate the CT findings of small bowel metastases from primary lung cancer. Of the 1468 patients with primary lung cancer between 1990 and 2000, 13 patients who had metastasis to the small intestine were collected. Of these 13 patients, nine who underwent CT scan were included for analysis. The pathologic diagnoses of primary lung cancer in these nine patients were squamous cell carcinoma in six, adenocarcinoma in two, and large cell carcinoma in one. CT scans were analyzed with regard to the site and patterns (intraluminal mass/bowel wall thickening/bowel implants) of metastatic masses, and the presence or absence of complication such as intussusception, obstruction, or perforation of the small bowel. The medical records of the patients were also reviewed retrospectively for evaluation of presenting abdominal symptom and time interval of metastases from initial diagnosis of lung cancer. Metastatic lesions were distributed throughout the small intestine: the duodenum in five, the jejunum in four, the ileum in six, and both jejunum and ileum in one patient. The size of metastatic masses of small bowel ranged from 1.3 cm to 5.0 cm (mean size, 2.6 cm) On CT, the small bowel was involved with intraluminal masses (mean size, 3.4 cm) in eight patients, diffuse wall thickening (mean thickness, 1.6 cm) in five, and bowel implants (mean size, 2.2 cm) in two. Complications occurred in seven patients, including intussusceptions without obstruction in two patients and with obstruction in two, obstruction without intussusceptions in two, and bowel perforation in one. Of 9 patients, 6 had at least one symptom referable to the small bowel including abdominal pain in 4, anemia in 3, vomiting in 1, and jaundice in 1. Lung cancer and small bowel lesions were detected simultaneously in four patients and the time interval of metastases from initial diagnosis of lung cancer ranged from 10 days to 30 months (median interval, 54 days) in patients. CT helps in defining the extent and

  20. [Small-cell lung cancer: epidemiology, diagnostics and therapy].

    Science.gov (United States)

    Pešek, Miloš; Mužík, Jan

    Authors present actual overview of information on diagnostic and therapeutic procedures in small-cell lung cancer (SCLC). This highly aggressive type of lung cancer is diagnosed in 14.8 % of Czech lung cancer patients. Vast majority of those patients (87 %) suffer from advanced and metastatic disease in the time of diagnosis. In this issue are presented prognostic factors, staging diagnostic procedures and therapeutic recommendations. The backbone of actual SCLC treatment is combined chemotherapy and radiotherapy and less frequently, carefully in selected cases, surgical procedures. SCLC should be have as chemosensitive, chemoresistent or chemorefractory disease. Actual cytostatic combinations used in 1st line treatment, different schedules of chemoradiotherapy, drugs used in second line treatment and schedules and timing of prophylactic brain irradiation are presented. In near future, perspectively, there are some promissible data on antitumour immunotherapy based on anti CTLA-4 and anti PD-1/PE-L1 antibodies also in SCLC patients.Key words: cancer immunotherapy - concomitant chemoradiotherapy - chemotherapy - chest radiotherapy - lung resections - prophylactic brain irradiation - small cell lung cancer.

  1. Hedgehog Pathway Inhibition Radiosensitizes Non-Small Cell Lung Cancers

    Energy Technology Data Exchange (ETDEWEB)

    Zeng, Jing; Aziz, Khaled; Chettiar, Sivarajan T. [Department of Radiation Oncology and Molecular Radiation Sciences, The Johns Hopkins University School of Medicine, Baltimore, Maryland (United States); Aftab, Blake T. [Department of Medical Oncology, The Johns Hopkins University School of Medicine, Baltimore, Maryland (United States); Armour, Michael; Gajula, Rajendra; Gandhi, Nishant; Salih, Tarek; Herman, Joseph M.; Wong, John [Department of Radiation Oncology and Molecular Radiation Sciences, The Johns Hopkins University School of Medicine, Baltimore, Maryland (United States); Rudin, Charles M. [Department of Medical Oncology, The Johns Hopkins University School of Medicine, Baltimore, Maryland (United States); Tran, Phuoc T. [Department of Radiation Oncology and Molecular Radiation Sciences, The Johns Hopkins University School of Medicine, Baltimore, Maryland (United States); Department of Medical Oncology, The Johns Hopkins University School of Medicine, Baltimore, Maryland (United States); Hales, Russell K., E-mail: rhales1@jhmi.edu [Department of Radiation Oncology and Molecular Radiation Sciences, The Johns Hopkins University School of Medicine, Baltimore, Maryland (United States)

    2013-05-01

    Purpose: Despite improvements in chemoradiation, local control remains a major clinical problem in locally advanced non-small cell lung cancer. The Hedgehog pathway has been implicated in tumor recurrence by promoting survival of tumorigenic precursors and through effects on tumor-associated stroma. Whether Hedgehog inhibition can affect radiation efficacy in vivo has not been reported. Methods and Materials: We evaluated the effects of a targeted Hedgehog inhibitor (HhAntag) and radiation on clonogenic survival of human non-small cell lung cancer lines in vitro. Using an A549 cell line xenograft model, we examined tumor growth, proliferation, apoptosis, and gene expression changes after concomitant HhAntag and radiation. In a transgenic mouse model of Kras{sup G12D}-induced and Twist1-induced lung adenocarcinoma, we assessed tumor response to radiation and HhAntag by serial micro-computed tomography (CT) scanning. Results: In 4 human lung cancer lines in vitro, HhAntag showed little or no effect on radiosensitivity. By contrast, in both the human tumor xenograft and murine inducible transgenic models, HhAntag enhanced radiation efficacy and delayed tumor growth. By use of the human xenograft model to differentiate tumor and stromal effects, mouse stromal cells, but not human tumor cells, showed significant and consistent downregulation of Hedgehog pathway gene expression. This was associated with increased tumor cell apoptosis. Conclusions: Targeted Hedgehog pathway inhibition can increase in vivo radiation efficacy in lung cancer preclinical models. This effect is associated with pathway suppression in tumor-associated stroma. These data support clinical testing of Hedgehog inhibitors as a component of multimodality therapy for locally advanced non-small cell lung cancer.

  2. CT volumetry of artificial pulmonary nodules using an ex vivo lung phantom: Influence of exposure parameters and iterative reconstruction on reproducibility

    Energy Technology Data Exchange (ETDEWEB)

    Wielpütz, Mark O., E-mail: Mark.wielpuetz@med.uni-heidelberg.de [Department of Diagnostic and Interventional Radiology, University Hospital of Heidelberg, Im Neuenheimer Feld 110, 69120 Heidelberg (Germany); Translational Lung Research Center (TLRC-H), German Center for Lung Research (DZL), Im Neuenheimer Feld 350, 69120 Heidelberg (Germany); Lederlin, Mathieu, E-mail: mathieu.lederlin@chu-bordeaux.fr [Department of Thoracic and Cardiovascular Imaging, University Hospital of Bordeaux, Av de Magellan, 33600 Pessac (France); Department of Radiology, German Cancer Research Center (dkfz), Im Neuenheimer Feld 280, 69120 Heidelberg (Germany); Wroblewski, Jacek, E-mail: JacekWr@gmx.net [Department of Diagnostic and Interventional Radiology, University Hospital of Heidelberg, Im Neuenheimer Feld 110, 69120 Heidelberg (Germany); Translational Lung Research Center (TLRC-H), German Center for Lung Research (DZL), Im Neuenheimer Feld 350, 69120 Heidelberg (Germany); Dinkel, Julien, E-mail: jdinkel@partners.org [Department of Radiology, Massachusetts General Hospital, 55 Fruit Street, Boston, MA 02114 (United States); Department of Radiology, German Cancer Research Center (dkfz), Im Neuenheimer Feld 280, 69120 Heidelberg (Germany); Translational Lung Research Center (TLRC-H), German Center for Lung Research (DZL), Im Neuenheimer Feld 350, 69120 Heidelberg (Germany); Eichinger, Monika, E-mail: Monika.eichinger@thoraxklinik-heidelberg.de [Department of Diagnostic and Interventional Radiology with Nuclear Medicine, Thoraxklinik at University of Heidelberg, Amalienstr. 5, 69126 Heidelberg (Germany); Translational Lung Research Center (TLRC-H), German Center for Lung Research (DZL), Im Neuenheimer Feld 350, 69120 Heidelberg (Germany); Department of Radiology, German Cancer Research Center (dkfz), Im Neuenheimer Feld 280, 69120 Heidelberg (Germany); and others

    2013-09-15

    Objectives: To evaluate the influence of exposure parameters and raw-data based iterative reconstruction (IR) on the measurement variability of computer-aided nodule volumetry on chest multidetector computed tomography (MDCT). Materials and methods: N = 7 porcine lung explants were inflated in a dedicated ex vivo phantom and prepared with n = 162 artificial nodules. MDCT was performed eight consecutive times (combinations of 120 and 80 kV with 120, 60, 30 and 12 mA s), and reconstructed with filtered back projection (FBP) and IR. Nodule volume and diameter were measured semi-automatically with dedicated software. The absolute percentage measurement error (APE) was computed in relation to the 120 kV 120 mA s acquisition. Noise was recorded for each nodule in every dataset. Results: Mean nodule volume and diameter were 0.32 ± 0.15 ml and 12.0 ± 2.6 mm, respectively. Although IR reduced noise by 24.9% on average compared to FBP (p < 0.007), APE with IR was equal to or slightly higher than with FBP. Mean APE for volume increased significantly below a volume computed tomography dose index (CTDI) of 1.0 mGy: for 120 kV 12 mA s APE was 3.8 ± 6.2% (FBP) vs. 4.0 ± 5.2% (IR) (p < 0.007); for 80 kV 12 mA s APE was 8.0 ± 13.0% vs. 9.3 ± 15.8% (n.s.), respectively. Correlating APE with image noise revealed that at identical noise APE was higher with IR than with FBP (p < 0.05). Conclusions: Computer-aided volumetry is robust in a wide range of exposure settings, and reproducibility is reduced at a CTDI below 1.0 mGy only, but the error rate remains clinically irrelevant. Noise reduction by IR is not detrimental for measurement error in the setting of semi-automatic nodule volumetry on chest MDCT.

  3. CT volumetry of artificial pulmonary nodules using an ex vivo lung phantom: Influence of exposure parameters and iterative reconstruction on reproducibility

    International Nuclear Information System (INIS)

    Wielpütz, Mark O.; Lederlin, Mathieu; Wroblewski, Jacek; Dinkel, Julien; Eichinger, Monika

    2013-01-01

    Objectives: To evaluate the influence of exposure parameters and raw-data based iterative reconstruction (IR) on the measurement variability of computer-aided nodule volumetry on chest multidetector computed tomography (MDCT). Materials and methods: N = 7 porcine lung explants were inflated in a dedicated ex vivo phantom and prepared with n = 162 artificial nodules. MDCT was performed eight consecutive times (combinations of 120 and 80 kV with 120, 60, 30 and 12 mA s), and reconstructed with filtered back projection (FBP) and IR. Nodule volume and diameter were measured semi-automatically with dedicated software. The absolute percentage measurement error (APE) was computed in relation to the 120 kV 120 mA s acquisition. Noise was recorded for each nodule in every dataset. Results: Mean nodule volume and diameter were 0.32 ± 0.15 ml and 12.0 ± 2.6 mm, respectively. Although IR reduced noise by 24.9% on average compared to FBP (p < 0.007), APE with IR was equal to or slightly higher than with FBP. Mean APE for volume increased significantly below a volume computed tomography dose index (CTDI) of 1.0 mGy: for 120 kV 12 mA s APE was 3.8 ± 6.2% (FBP) vs. 4.0 ± 5.2% (IR) (p < 0.007); for 80 kV 12 mA s APE was 8.0 ± 13.0% vs. 9.3 ± 15.8% (n.s.), respectively. Correlating APE with image noise revealed that at identical noise APE was higher with IR than with FBP (p < 0.05). Conclusions: Computer-aided volumetry is robust in a wide range of exposure settings, and reproducibility is reduced at a CTDI below 1.0 mGy only, but the error rate remains clinically irrelevant. Noise reduction by IR is not detrimental for measurement error in the setting of semi-automatic nodule volumetry on chest MDCT

  4. The feasibility of 11C-methionine-PET in diagnosis of solitary lung nodules/masses when compared with 18F-FDG-PET

    International Nuclear Information System (INIS)

    Hsieh Hungjen; Lin Shenghsiang; Lin Kohan; Lee Chienying; Chang Chengpei; Wang Shyhjen

    2008-01-01

    The objective of this study was to differentiate between benign and malignant lesions of the lung, 18 F-fluorodeoxyglucose positron emission tomography ( 18 F-FDG-PET) has limitations such as a lower specificity in cases of non-specific inflammation. The positive predictive value is unsatisfactory in countries where inflammatory lung disorders are prevalent. We present the preliminary results of the usefulness of combining 11 C-methionine-PET and 18 F-FDG-PET in this context. Fifteen patients with indeterminate solitary pulmonary nodules/masses (10 men, 5 women; average age 64.7±14.0 years, ranging from 25 to 87 years) were studied using 11 C-methionine- and 18 F-FDG-PET. Interpretations were primarily made on visual analysis with five-point scale and a consensus of two nuclear medicine physicians, using standardized uptake value as an accessory reference. Foci of abnormal radiotracer uptake were subsequently correlated with clinical follow-up, imaging modalities such as chest radiography, chest computed tomography (CT), serial PET studies, and pathology results from bronchoscopic biopsy and/or surgical specimen. Diagnoses were established in 14 patients. The 11 C-methionine-PET and 18 F-FDG-PET studies were both true positive in two cases of adenocarcinoma and true negative in two cases of clinical benign nodules. In one case of lymphoid hyperplasia both 11 C-methionine-PET and 18 F-FDG-PET showed false-positive findings. Discordant results were obtained in nine cases. In spite of the false-positive results of 18 F-FDG-PET, 11 C-methionine-PET was true negative in four cases with chronic inflammatory nodules and three cases of pulmonary tuberculosis. Furthermore, 11 C-methionine-PET was true positive in one case of lung metastasis of thyroid cancer, and in another with recurrence of gastric cancer, respectively, for which 18 F-FDG-PET imaging was false negative. Our experience indicates that 11 C-methionine-PET seems more specific and sensitive when compared with

  5. Spontaneous Regression of Pulmonary Nodules Presenting as Epstein-Barr Virus-related Atypical Infectious Mononucleosis.

    Science.gov (United States)

    Shinozuka, Jun; Awaguni, Hitoshi; Tanaka, Shin-Ichiro; Makino, Shigeru; Maruyama, Rikken; Inaba, Tohru; Imashuku, Shinsaku

    2016-07-01

    Pulmonary nodules associated with Epstein-Barr virus (EBV)-related atypical infectious mononucleosis have rarely been described. A 12-year-old Japanese boy, upon admission, revealed multiple small round nodules (a total of 7 nodules in 4 to 8 mm size) in the lungs on computed tomography. The hemorrhagic pharyngeal tonsils with hot signals on 18F-fluorodeoxyglucose-positron emission tomography-computed tomography were biopsied revealing the presence of EBV-encoded small nuclear RNA (EBER)-positive cells; however, no lymphoma was noted. The patient was diagnosed as having atypical EBV-infectious mononucleosis associated with primary EBV infection. Pulmonary nodules markedly reduced in numbers and sizes spontaneously over a 2-year period. Differential diagnosis of pulmonary nodules in childhood should include atypical EBV infection.

  6. Validation of the modified 4-tiered categorization system through comparison with the 5-tiered categorization system of the 2015 American Thyroid Association guidelines for classifying small thyroid nodules on ultrasound.

    Science.gov (United States)

    Lee, Ji Hye; Han, Kyunghwa; Kim, Eun-Kyung; Moon, Hee Jung; Yoon, Jung Hyun; Park, Vivian Y; Kwak, Jin Young

    2017-11-01

    The purpose of this study was to validate the modified 4-tiered categorization system and to compare stratification of malignancy risk in small thyroid nodules with the 2015 American Thyroid Association (ATA) management guidelines. From January 2015 to December 2015, 737 thyroid nodules measured ≥ 1 cm and categorization, which combines very low suspicion and low suspicion nodules into the "revised low suspicion" category. Specificity, positive predictive value (PPV) and accuracy were higher with the modified 4-tiered categorization system (P categorization system allows more efficient management with better diagnostic performance than the 2015 ATA categorization system in small thyroid nodules. © 2017 Wiley Periodicals, Inc.

  7. Personalizing Therapy in Advanced Non–Small Cell Lung Cancer

    Science.gov (United States)

    Villaruz, Liza C.; Burns, Timothy F.; Ramfidis, Vasilis S.; Socinski, Mark A.

    2016-01-01

    The recognition that non–small cell lung cancer (NSCLC) is not a single disease entity, but rather a collection of distinct molecularly driven neoplasms, has permanently shifted the therapeutic landscape of NSCLC to a personalized approach. This personalization of NSCLC therapy is typified by the dramatic response rates seen in EGFR mutant NSCLC when treated with targeted tyrosine kinase inhibitor therapy and in ALK translocation–driven NSCLC when treated with ALK inhibitors. Targeted therapeutic approaches in NSCLC necessitate consideration of more invasive biopsy techniques aimed at providing sufficient tissue for both histological determination and molecular profiling in all patients with stage IV disease both at the time of diagnosis and at the time of disease progression. Comprehensive genotyping efforts have identified oncogenic drivers in 62% lung adenocarcinomas and an increasing proportion of squamous cell carcinomas of the lung. The identification of these oncogenic drivers and the triage of patients to clinical trials evaluating novel targeted therapeutic approaches will increasingly mold a landscape of personalized lung cancer therapy where each genotype has an associated targeted therapy. This review outlines the state of personalized lung cancer therapy as it pertains to individual NSCLC genotypes. PMID:24258572

  8. Thyroid nodule

    International Nuclear Information System (INIS)

    McKenney, J.F.

    1975-01-01

    A palpable mass or nodule may represent any one of a large and diverse group of conditions that involve the thyroid. Whether the patient is euthyroid, hypothyroid, or hyperthyroid can be assessed, and the cause of hypofunction or hyperfunction can usually be determined. Scintiscanning provides important information on the anatomic structure of thyroid nodules. A hot nodule should be ablated by either radioiodine or surgery. A warm nodule usually responds to suppression therapy; if regression does not occur, the problem should be reevaluated. A cold nodule should be surgically excised, as microscopic study of such a lesion is mandatory

  9. Diagnosing lung nodules on oncologic MR/PET imaging: Comparison of fast T1-weighted sequences and influence of image acquisition in inspiration and expiration breath-hold

    Energy Technology Data Exchange (ETDEWEB)

    Schwenzer, Nina F.; Seith, Ferdinand; Gatidis, Sergios; Brendle, Cornelia; Schmidt, Holger; Pfannenberg, Christina A; LaFougère, Christian; Nikolaou, Konstantin; Schraml, Christina [University Hospital of Tuebingen, Tuebingen (Germany)

    2016-09-15

    First, to investigate the diagnostic performance of fast T1-weighted sequences for lung nodule evaluation in oncologic magnetic resonance (MR)/positron emission tomography (PET). Second, to evaluate the influence of image acquisition in inspiration and expiration breath-hold on diagnostic performance. The study was approved by the local Institutional Review Board. PET/CT and MR/PET of 44 cancer patients were evaluated by 2 readers. PET/CT included lung computed tomography (CT) scans in inspiration and expiration (CTin, CTex). MR/PET included Dixon sequence for attenuation correction and fast T1-weighted volumetric interpolated breath-hold examination (VIBE) sequences (volume interpolated breath-hold examination acquired in inspiration [VIBEin], volume interpolated breath-hold examination acquired in expiration [VIBEex]). Diagnostic performance was analyzed for lesion-, lobe-, and size-dependence. Diagnostic confidence was evaluated (4-point Likert-scale; 1 = high). Jackknife alternative free-response receiver-operating characteristic (JAFROC) analysis was performed. Seventy-six pulmonary lesions were evaluated. Lesion-based detection rates were: CTex, 77.6%; VIBEin, 53.3%; VIBEex, 51.3%; and Dixon, 22.4%. Lobe-based detection rates were: CTex, 89.6%; VIBEin, 58.3%; VIBEex, 60.4%; and Dixon, 31.3%. In contrast to CT, inspiration versus expiration did not alter diagnostic performance in VIBE sequences. Diagnostic confidence was best for VIBEin and CTex and decreased in VIBEex and Dixon (1.2 ± 0.6; 1.2 ± 0.7; 1.5 ± 0.9; 1.7 ± 1.1, respectively). The JAFROC figure-of-merit of Dixon was significantly lower. All patients with malignant lesions were identified by CTex, VIBEin, and VIBEex, while 3 patients were false-negative in Dixon. Fast T1-weighted VIBE sequences allow for identification of patients with malignant pulmonary lesions. The Dixon sequence is not recommended for lung nodule evaluation in oncologic MR/PET patients. In contrast to CT, inspiration versus

  10. Diagnosing Lung Nodules on Oncologic MR/PET Imaging: Comparison of Fast T1-Weighted Sequences and Influence of Image Acquisition in Inspiration and Expiration Breath-Hold

    Energy Technology Data Exchange (ETDEWEB)

    Schwenzer, Nina F.; Seith, Ferdinand; Gatidis, Sergios [Department of Diagnostic and Interventional Radiology, University Hospital of Tuebingen, Tuebingen 72076 (Germany); Brendle, Cornelia [Department of Diagnostic and Interventional Radiology, University Hospital of Tuebingen, Tuebingen 72076 (Germany); Department of Diagnostic and Interventional Neuroradiology, University Hospital of Tuebingen, Tuebingen 72076 (Germany); Schmidt, Holger; Pfannenberg, Christina A. [Department of Diagnostic and Interventional Radiology, University Hospital of Tuebingen, Tuebingen 72076 (Germany); Fougère, Christian la [Department of Nuclear Medicine, University Hospital of Tuebingen, Tuebingen 72076 (Germany); Nikolaou, Konstantin; Schraml, Christina [Department of Diagnostic and Interventional Radiology, University Hospital of Tuebingen, Tuebingen 72076 (Germany)

    2016-11-01

    First, to investigate the diagnostic performance of fast T1-weighted sequences for lung nodule evaluation in oncologic magnetic resonance (MR)/positron emission tomography (PET). Second, to evaluate the influence of image acquisition in inspiration and expiration breath-hold on diagnostic performance. The study was approved by the local Institutional Review Board. PET/CT and MR/PET of 44 cancer patients were evaluated by 2 readers. PET/CT included lung computed tomography (CT) scans in inspiration and expiration (CTin, CTex). MR/PET included Dixon sequence for attenuation correction and fast T1-weighted volumetric interpolated breath-hold examination (VIBE) sequences (volume interpolated breath-hold examination acquired in inspiration [VIBEin], volume interpolated breath-hold examination acquired in expiration [VIBEex]). Diagnostic performance was analyzed for lesion-, lobe-, and size-dependence. Diagnostic confidence was evaluated (4-point Likert-scale; 1 = high). Jackknife alternative free-response receiver-operating characteristic (JAFROC) analysis was performed. Seventy-six pulmonary lesions were evaluated. Lesion-based detection rates were: CTex, 77.6%; VIBEin, 53.3%; VIBEex, 51.3%; and Dixon, 22.4%. Lobe-based detection rates were: CTex, 89.6%; VIBEin, 58.3%; VIBEex, 60.4%; and Dixon, 31.3%. In contrast to CT, inspiration versus expiration did not alter diagnostic performance in VIBE sequences. Diagnostic confidence was best for VIBEin and CTex and decreased in VIBEex and Dixon (1.2 ± 0.6; 1.2 ± 0.7; 1.5 ± 0.9; 1.7 ± 1.1, respectively). The JAFROC figure-of-merit of Dixon was significantly lower. All patients with malignant lesions were identified by CTex, VIBEin, and VIBEex, while 3 patients were false-negative in Dixon. Fast T1-weighted VIBE sequences allow for identification of patients with malignant pulmonary lesions. The Dixon sequence is not recommended for lung nodule evaluation in oncologic MR/PET patients. In contrast to CT, inspiration versus

  11. The incidental pulmonary nodule in a child. Part 2: Commentary and suggestions for clinical management, risk communication and prevention

    International Nuclear Information System (INIS)

    Westra, Sjirk J.; Thacker, Paul G.; Podberesky, Daniel J.; Lee, Edward Y.; Iyer, Ramesh S.; Hegde, Shilpa V.; Guillerman, R.P.; Mahani, Maryam Ghadimi

    2015-01-01

    The incidental detection of small lung nodules in children is a vexing consequence of an increased reliance on CT. We present an algorithm for the management of lung nodules detected on CT in children, based on the presence or absence of symptoms, the presence or absence of elements in the clinical history that might explain these nodules, and the imaging characteristics of the nodules (such as attenuation measurements within the nodule). We provide suggestions on how to perform a thoughtfully directed and focused search for clinically occult extrathoracic disease processes (including malignant disease) that may present as an incidentally detected lung nodule on CT. This algorithm emphasizes that because of the lack of definitive information on the natural history of small solid nodules that are truly detected incidentally, their clinical management is highly dependent on the caregivers' individual risk tolerance. In addition, we present strategies to reduce the prevalence of these incidental findings, by preventing unnecessary chest CT scans or inadvertent inclusion of portions of the lungs in scans of adjacent body parts. Application of these guidelines provides pediatric radiologists with an important opportunity to practice patient-centered and evidence-based medicine. (orig.)

  12. Approach for oligometastasis in non-small cell lung cancer.

    Science.gov (United States)

    Suzuki, Hidemi; Yoshino, Ichiro

    2016-04-01

    Non-small cell lung cancer (NSCLC) harboring a limited number of distant metastases, referred to as the oligometastatic state, has been indicated for surgery for the past several decades. However, whether the strategy of surgical treatment results in a survival benefit for such patients remains controversial. Experientially, however, thoracic surgeons often encounter long-term survivors among surgically resected oligometastatic NSCLC patients. In this article, the current situation of surgical approach and potential future perspective for oligometastatic NSCLC are reviewed.

  13. Definitive Radiotherapy of Non-Small Cell Lung Cancer

    International Nuclear Information System (INIS)

    Lee, Jong Young; Park, Kyung Ran

    1995-01-01

    Purpose : The effect of dose escalation of up to 6500 cGy on local control and survival was investigated in locally advanced non-small cell lung cancer. Materials and Methods : Ninety eight patients with biopsy-proven unresectable non-small cell lung cancer without distant metastases or medically inoperable patients with lower-stage were treated with definitive radiotherapy alone. Group A were treated by thoracic irradiation, 6000 cGy or less in total tumor dose with daily fractions of 180 to 200 cGy: and group B was treated with 6500 cGy of same daily fractions. Results : The actuarial overall survival rate for the entire group was 54% at 1 year, 26.6% at 2 years and 16.4% at 3 years with a median survival time of 13 months. Statistically significant prognostic factors that affect survival rate were stage and N-stage. However, no improvement in local control and survival has been seen with higher dose radiotherapy(group B). Conclusion : Dose escalation of up to 6500 cGy was no effect on local control and survival rate. To increase the survival rate of non-small cell lung cancer hyperfractionated radiotherapy or concurrent chemoradiotherapy should be considered

  14. Change from lung adenocarcinoma to small cell lung cancer as a mechanism of resistance to afatinib.

    Science.gov (United States)

    Manca, Paolo; Russano, Marco; Pantano, Francesco; Tonini, Giuseppe; Santini, Daniele

    2017-08-29

    We report the case of a patient affected by advanced EGFR mutation-positive lung who experienced resistance to therapy during treatment with Afatinib through the occurrence of a switch of tumor histotype to small cell lung cancer (SCLC) with features of a G3 neuroendocrine carcinoma. Unexpectedly, the switch to SCLC histotype occurred in the only site not responsive to afatinib and subsequently the most responsive to chemotherapy. Our case shows that occurrence of switch to SCLC is a possible mechanism of resistance during treatment with Afatinib.

  15. Nodule detection methods using autocorrelation features on 3D chest CT scans

    International Nuclear Information System (INIS)

    Hara, T.; Zhou, X.; Okura, S.; Fujita, H.; Kiryu, T.; Hoshi, H.

    2007-01-01

    Lung cancer screening using low dose X-ray CT scan has been an acceptable examination to detect cancers at early stage. We have been developing an automated detection scheme for lung nodules on CT scan by using second-order autocorrelation features and the initial performance for small nodules (< 10 mm) shows a high true-positive rate with less than four false-positive marks per case. In this study, an open database of lung images, LIDC (Lung Image Database Consortium), was employed to evaluate our detection scheme as an consistency test. The detection performance for solid and solitary nodules in LIDC, included in the first data set opened by the consortium, was 83% (10/12) true-positive rate with 3.3 false-positive marks per case. (orig.)

  16. Detection of pulmonary nodules on lung X-ray images. Studies on multi-resolutional filter and energy subtraction images

    International Nuclear Information System (INIS)

    Sawada, Akira; Sato, Yoshinobu; Kido, Shoji; Tamura, Shinichi

    1999-01-01

    The purpose of this work is to prove the effectiveness of an energy subtraction image for the detection of pulmonary nodules and the effectiveness of multi-resolutional filter on an energy subtraction image to detect pulmonary nodules. Also we study influential factors to the accuracy of detection of pulmonary nodules from viewpoints of types of images, types of digital filters and types of evaluation methods. As one type of images, we select an energy subtraction image, which removes bones such as ribs from the conventional X-ray image by utilizing the difference of X-ray absorption ratios at different energy between bones and soft tissue. Ribs and vessels are major causes of CAD errors in detection of pulmonary nodules and many researches have tried to solve this problem. So we select conventional X-ray images and energy subtraction X-ray images as types of images, and at the same time select ∇ 2 G (Laplacian of Guassian) filter, Min-DD (Minimum Directional Difference) filter and our multi-resolutional filter as types of digital filters. Also we select two evaluation methods and prove the effectiveness of an energy subtraction image, the effectiveness of Min-DD filter on a conventional X-ray image and the effectiveness of multi-resolutional filter on an energy subtraction image. (author)

  17. Multilevel binomial logistic prediction model for malignant pulmonary nodules based on texture features of CT image

    International Nuclear Information System (INIS)

    Wang Huan; Guo Xiuhua; Jia Zhongwei; Li Hongkai; Liang Zhigang; Li Kuncheng; He Qian

    2010-01-01

    Purpose: To introduce multilevel binomial logistic prediction model-based computer-aided diagnostic (CAD) method of small solitary pulmonary nodules (SPNs) diagnosis by combining patient and image characteristics by textural features of CT image. Materials and methods: Describe fourteen gray level co-occurrence matrix textural features obtained from 2171 benign and malignant small solitary pulmonary nodules, which belongs to 185 patients. Multilevel binomial logistic model is applied to gain these initial insights. Results: Five texture features, including Inertia, Entropy, Correlation, Difference-mean, Sum-Entropy, and age of patients own aggregating character on patient-level, which are statistically different (P < 0.05) between benign and malignant small solitary pulmonary nodules. Conclusion: Some gray level co-occurrence matrix textural features are efficiently descriptive features of CT image of small solitary pulmonary nodules, which can profit diagnosis of earlier period lung cancer if combined patient-level characteristics to some extent.

  18. Sirolimus and Gold Sodium Thiomalate in Treating Patients With Advanced Squamous Non-Small Cell Lung Cancer

    Science.gov (United States)

    2012-12-13

    Recurrent Non-small Cell Lung Cancer; Squamous Cell Lung Cancer; Stage IIIA Non-small Cell Lung Cancer; Stage IIIB Non-small Cell Lung Cancer; Stage IV Non-small Cell Lung Cancer; Unspecified Adult Solid Tumor, Protocol Specific

  19. [Thyroid nodule].

    Science.gov (United States)

    Clerc, Jérôme

    2005-01-31

    The thyroid nodule is a frequent, most often benign, chronic, multifocal and slowly progressive disease. The first line strategy is to diagnose cancerous nodules (thyroid nodules is controversial since the prognosis of thyroid cancer is excellent for lesions measuring less than 20 mm. Though imaging accuracy is quite limited in assessing the diagnosis of thyroid cancer, both ultrasounds (US) and thyroid scan are helpful to enhance nodular identification (>30%), to sort the nodules relevant for cytological sampling and to optimize the follow-up, the major source of health costs. Suspicious and non contributive FNAs must have a control FNA within 6 months. Nodules with a non suspicious FNA (>85%) require long term follow-up. This follow-up is mainly morphological. New or evolutive nodules, as assessed by palpation or US, will require iterative FNAs or should be considered for surgery. In patients with hyperfunctioning nodules on the scan (10 to 20%), a yearly evaluation of the TSH level is sufficient. These nodules account either for autonomously functioning ones, which slowly develop towards thyrotoxicosis, or for hyperplastic nodules frequently disclosing a lymphocytic thyroiditis. Morbidity due to thyroid autonomy is still underestimated especially in aging patients with TSH levels thyroid nodule is suggested.

  20. The diagnosis of small solitary pulmonary nodule: comparison of standard and inverse digital images on a high resolution monitor using ROC analysis

    International Nuclear Information System (INIS)

    Choi, Byeong Kyoo; Lee, In Sun; Seo, Joon Beom; Lee, Jin Seong; Song, Koun Sik; Lim, Tae Hwan

    2002-01-01

    To study the impact of inversion of soft-copy chest radiographs on the detection of small solitary pulmonary nodules using a high-resolution monitor. The study group consisted of 80 patients who had undergone posterior chest radiography; 40 had a solitary noncalcified pulmonary nodule approximately 1 cm in diameter, and 40 were control subjects. Standard and inverse digital images using the inversion tool on a PACS system were displayed on high-resolution monitors (2048x2560x8 bit). Ten radiologists were requested to rank each image using a five-point scale (1=definitely negative, 3=equivocal or indeterminate, 5=definite nodule), and the data were interpreted using receiver operating characteristic (ROC) analysis. The area under the ROC curve for pooled data of standard image sets was significantly larger than that of inverse image sets (0.8893 and 0.8095, respectively; p 0.05). For detecting small solitary pulmonary nodules, inverse digital images were significantly inferior to standard digital images

  1. Phased searching with NEAT in a time-scaled framework: experiments on a computer-aided detection system for lung nodules.

    Science.gov (United States)

    Tan, Maxine; Deklerck, Rudi; Cornelis, Jan; Jansen, Bart

    2013-11-01

    In the field of computer-aided detection (CAD) systems for lung nodules in computed tomography (CT) scans, many image features are presented and many artificial neural network (ANN) classifiers with various structural topologies are analyzed; frequently, the classifier topologies are selected by trial-and-error experiments. To avoid these trial and error approaches, we present a novel classifier that evolves ANNs using genetic algorithms, called "Phased Searching with NEAT in a Time or Generation-Scaled Framework", integrating feature selection with the classification task. We analyzed our method's performance on 360 CT scans from the public Lung Image Database Consortium database. We compare our method's performance with other more-established classifiers, namely regular NEAT, Feature-Deselective NEAT (FD-NEAT), fixed-topology ANNs, and support vector machines (SVMs) using ten-fold cross-validation experiments of all 360 scans. The results show that the proposed "Phased Searching" method performs better and faster than regular NEAT, better than FD-NEAT, and achieves sensitivities at 3 and 4 false positives (FP) per scan that are comparable with the fixed-topology ANN and SVM classifiers, but with fewer input features. It achieves a detection sensitivity of 83.0±9.7% with an average of 4FP/scan, for nodules with a diameter greater than or equal to 3mm. It also evolves networks with shorter evolution times and with lower complexities than regular NEAT (p=0.026 and pNEAT and by our approach shows that our approach searches for good solutions in lower dimensional search spaces, and evolves networks without superfluous structure. We have presented a novel approach that combines feature selection with the evolution of ANN topology and weights. Compared with the original threshold-based Phased Searching method of Green, our method requires fewer parameters and converges to the optimal network complexity required for the classification task at hand. The results of the

  2. Computer-aided detection (CAD) of lung nodules and small tumours on chest radiographs

    International Nuclear Information System (INIS)

    De Boo, D.W.; Prokop, M.; Uffmann, M.; Ginneken, B. van; Schaefer-Prokop, C.M.

    2009-01-01

    Detection of focal pulmonary lesions is limited by quantum and anatomic noise and highly influenced by variable perception capacity of the reader. Multiple studies have proven that lesions - missed at time of primary interpretation - were visible on the chest radiographs in retrospect. Computer-aided diagnosis (CAD) schemes do not alter the anatomic noise but aim at decreasing the intrinsic limitations and variations of human perception by alerting the reader to suspicious areas in a chest radiograph when used as a 'second reader'. Multiple studies have shown that the detection performance can be improved using CAD especially for less experienced readers at a variable amount of decreased specificity. There seem to be a substantial learning process for both, experienced and inexperienced readers, to be able to optimally differentiate between false positive and true positive lesions and to build up sufficient trust in the capabilities of these systems to be able to use them at their full advantage. Studies so far focussed on stand-alone performance of the CAD schemes to reveal the magnitude of potential impact or on retrospective evaluation of CAD as a second reader for selected study groups. Further research is needed to assess the performance of these systems in clinical routine and to determine the trade-off between performance increase in terms of increased sensitivity and decreased inter-reader variability and loss of specificity and secondary indicated follow-up examinations for further diagnostic workup.

  3. Management of non-small cell lung cancer with oligometastasis.

    Science.gov (United States)

    Villaruz, Liza C; Kubicek, Gregory J; Socinski, Mark A

    2012-08-01

    Patients with oligometastatic Non-Small Cell Lung Cancer (NSCLC) present a potential opportunity for curative therapy; however, the challenge remains the definitive treatment of their localized disease and ablation of their limited overt metastatic sites of disease. In selecting patients with oligometastatic NSCLC for definitive therapy, proper staging through radiographic studies, including PET and brain MRI, and the pathologic staging of the mediastinal lymph nodes and potential sites of metastatic disease, are critical. With that in mind, the available literature suggests that in highly selected patients with solitary metastases to the brain, adrenals and other organs, long term survival may be achieved with combined definitive therapy of both the primary lung tumor and the solitary metastatic site.

  4. Surgical treatment in non-small cell lung cancer with pulmonary oligometastasis.

    Science.gov (United States)

    He, Jinyuan; Li, Yun; An, Jun; Hu, Liu; Zhang, Junhang

    2017-02-02

    Previous studies have demonstrated survival benefits for local treatment in solitary metastatic non-small cell lung cancer (NSCLC).This study aimed to investigate the effect of local surgery for NSCLC with pulmonary oligometastasis. This study included 21 patients of NSCLC with pulmonary oligometastasis between January 2003 and December 2013, which were divided into two groups, group A (11 cases) for local surgery and group B (10 cases) for systematic chemotherapy, compared the median survival time (MST) and 5-year survival rate between the two groups, and analyzed the impact of the pathological types, the TNM and pN stage of primary tumor, the site, and the mode and number of oligometastatic nodule on group A. The MST of group A and B were 37 and 11.6 months respectively, 5-year survival rates were 18.2 and 9.1% respectively (p  0.05). Local surgery significantly prolonged the overall survival time and 5-year survival rate of primary NSCLC with pulmonary oligometastasis.

  5. MR microscopy of the lung in small rodents

    International Nuclear Information System (INIS)

    Takahashi, Masaya; Kubo, Shigeto; Kiryu, Shigeru; Gee, James; Hatabu, Hiroto

    2007-01-01

    Understanding how the mammalian respiratory system works and how it changes in disease states and under the influence of drugs is frequently pursued in model systems such as small rodents. These have many advantages, including being easily obtained in large numbers as purebred strains. Studies in small rodents are valuable for proof of concept studies and for increasing our knowledge about disease mechanisms. Since the recent developments in the generation of genetically designed animal models of disease, one needs the ability to assess morphology and function in in vivo systems. In this article, we first review previous reports regarding thoracic imaging. We then discuss approaches to take in making use of small rodents to increase MR microscopic sensitivity for these studies and to establish MR methods for clinically relevant lung imaging

  6. Electromagnetic navigation diagnostic bronchoscopy for small peripheral lung lesions.

    Science.gov (United States)

    Makris, D; Scherpereel, A; Leroy, S; Bouchindhomme, B; Faivre, J-B; Remy, J; Ramon, P; Marquette, C-H

    2007-06-01

    The present study prospectively evaluated the diagnostic yield and safety of electromagnetic navigation-guided bronchoscopy biopsy, for small peripheral lung lesions in patients where standard techniques were nondiagnostic. The study was conducted in a tertiary medical centre on 40 consecutive patients considered unsuitable for straightforward surgery or computed tomography (CT)-guided transthoracic needle aspiration biopsy, due to comorbidities. The lung lesion diameter was mean+/-sem 23.5+/-1.5 mm and the depth from the visceral-costal pleura was 14.9+/-2 mm. Navigation was facilitated by an electromagnetic tracking system which could detect a position sensor incorporated into a flexible catheter advanced through a bronchoscope. Information obtained during bronchoscopy was superimposed on previously acquired CT data. Divergence between CT data and data obtained during bronchoscopy was calculated by the system's software as a measure of navigational accuracy. All but one of the target lesions was reached and the overall diagnostic yield was 62.5% (25-40). Diagnostic yield was significantly affected by CT-to-body divergence; yield was 77.2% when estimated divergence was drainage was required in one case. Electromagnetic navigation-guided bronchoscopy has the potential to improve the diagnostic yield of transbronchial biopsies without additional fluoroscopic guidance, and may be useful in the early diagnosis of lung cancer, particularly in nonoperable patients.

  7. Role of Computer Aided Diagnosis (CAD in the detection of pulmonary nodules on 64 row multi detector computed tomography

    Directory of Open Access Journals (Sweden)

    K Prakashini

    2016-01-01

    Full Text Available Aims and Objectives: To determine the overall performance of an existing CAD algorithm with thin-section computed tomography (CT in the detection of pulmonary nodules and to evaluate detection sensitivity at a varying range of nodule density, size, and location. Materials and Methods: A cross-sectional prospective study was conducted on 20 patients with 322 suspected nodules who underwent diagnostic chest imaging using 64-row multi-detector CT. The examinations were evaluated on reconstructed images of 1.4 mm thickness and 0.7 mm interval. Detection of pulmonary nodules, initially by a radiologist of 2 years experience (RAD and later by CAD lung nodule software was assessed. Then, CAD nodule candidates were accepted or rejected accordingly. Detected nodules were classified based on their size, density, and location. The performance of the RAD and CAD system was compared with the gold standard that is true nodules confirmed by consensus of senior RAD and CAD together. The overall sensitivity and false-positive (FP rate of CAD software was calculated. Observations and Results: Of the 322 suspected nodules, 221 were classified as true nodules on the consensus of senior RAD and CAD together. Of the true nodules, the RAD detected 206 (93.2% and 202 (91.4% by the CAD. CAD and RAD together picked up more number of nodules than either CAD or RAD alone. Overall sensitivity for nodule detection with the CAD program was 91.4%, and FP detection per patient was 5.5%. The CAD showed comparatively higher sensitivity for nodules of size 4-10 mm (93.4% and nodules in hilar (100% and central (96.5% location when compared to RAD′s performance. Conclusion: CAD performance was high in detecting pulmonary nodules including the small size and low-density nodules. CAD even with relatively high FP rate, assists and improves RAD′s performance as a second reader, especially for nodules located in the central and hilar region and for small nodules by saving RADs time.

  8. Chromogenic in situ hybridization to detect EGFR gene copy number in cell blocks from fine-needle aspirates of non small cell lung carcinomas and lung metastases from colo-rectal cancer

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    Terrenato Irene

    2010-09-01

    Full Text Available Abstract Background Several studies demonstrated that epidermal growth factor receptor (EGFR gene copy number (GCN correlates to the response to tyrosine kinase inhibitors in non small cell lung cancer (NSCLC and to anti-EGFR monoclonal antibodies (MoAbs in metastatic colorectal cancer (CRC. In the presence of lung nodules, cytology is often the only possible diagnostic approach. Chromogenic in situ hybridization (CISH is an alternative technique to fluorescence in situ hybridization (FISH, but its feasibility in detecting EGFR GCN in cell blocks from fine-needle aspiration cytology (FNAC of lung nodules has not yet been established. Methods We evaluated the feasibility of CISH on 33 FNAC from 20 primary NSCLC (5 squamous carcinomas, 8 large cell carcinomas and 7 adenocarcinomas and 13 lung metastases from CRC. Results Of the 33 FNAC analyzed by CISH, 27 (82% presented a balanced increase in EGFR gene and chromosome 7 number: 10 cases (30% showed a low polysomy, 15 (45% a high polysomy and 2 (6% NSCLC were amplified. No significant differences between NSCLC and CRC lung metastases were found in relation to disomic or polysomic status. In addition, no correlation between EGFR GCN and EGFR immunohistochemical overexpression was found. Furthermore, we compared CISH results with those obtained by FISH on the same samples and we found 97% overall agreement between the two assays (k = 0.78, p Conclusions Our study shows that CISH is a valid method to detect EGFR GCN in cell blocks from FNAC of primary NSCLC or metastatic CRC to the lung.

  9. Treatment of initially metastatic small-cell lung cancer

    International Nuclear Information System (INIS)

    Kohutek, F.; Bystricky, B.; Tamasova, M.

    2013-01-01

    Lung cancer (LC) is the most common cause of death associated with neoplasms. The incidence of LC in 2007 was 71.3/100,000 men and 18.6/100,000 women in Slovakia. Small-cell lung cancer (SCLC) includes 15 - 18% of all cases. The diagnosis of LC is based on patient's history, physical examination, basic laboratory tests, x-ray imaging and computed tomography (CT) imaging and histology. The material required for histology can be obtained by means of endoscopy or surgery. Ultrasonography (USG) and/or CT of abdomen is commonly performed as a part of staging process, along with CT or MRI of brain. Bone scan is performed in case of suspicion of bone involvement. According to TNM classification, seventh edition, the same classification can be used for SCLC and non-small cell lung cancer (NSCLC). Chemotherapy and radiotherapy are available for treatment of initially metastatic SCLC. First-line chemotherapy regimen should be based on combination of cisplatin or carboplatin with etoposide (PE). Alternatively, CAV regimen (cyclophosphamide, doxorubicin, vincristine) can be used. Newer regimens did not provide benefit when compared to standard regimens. If progression occurs later than 3 months after finishing first-line chemotherapy, the same regimen may be used in second-line chemotherapy. If progression occurs earlier than 3 months after finishing first-line chemotherapy, topotecan-based regimen is an option for second-line line chemotherapy. Despite promising outcomes of amrubicin-based second-line chemotherapy in Japan, amrubicin is not available in countries of E U. Standard therapy schedules do not include radiotherapy targeted on primary tumor and affected lymph-nodes. According to American and European guidelines, prophylactic cranial irradiation is recommended for patients with extensive disease-SCLC with good performance status after achieving complete or partial response to first-line chemotherapy. (author)

  10. Role of Immune Checkpoint Inhibitors in Small Cell Lung Cancer.

    Science.gov (United States)

    Cooper, Maryann R; Alrajhi, Abdullah M; Durand, Cheryl R

    Small cell lung cancer (SCLC) accounts for approximately 13% of all lung cancer diagnoses each year. SCLC is characterized by a rapid doubling time, early metastatic spread, and an unfavorable prognosis overall. Most patients with SCLC will respond to initial treatment; however, the majority will experience a disease recurrence and response to second-line therapies is poor. Immune checkpoint inhibitors may be an option given the success in other diseases. A literature search was conducted using Medline (1946-July week 1, 2017) and Embase (1996-2017 week 28) with the search terms small cell lung cancer combined with nivolumab or ipilimumab or pembrolizumab or atezolizumab or tremelimumab or durvalumab. Five clinical trials, including extended follow-up for 2, that evaluated immune checkpoint inhibitors in limited stage or extensive stage SCLC were included. In 2 phase 2 trials, ipilimumab was added to upfront chemotherapy. In both trials, an improvement in progression-free survival was seen. Toxicity, when combined with a platinum and etoposide, was significant. In a confirmatory phase 3 trial, ipilimumab did not prolong overall survival when added to first-line chemotherapy. Overall, response rates were similar between the placebo and ipilimumab groups. A phase 1/2 trial evaluated nivolumab alone or in combination with ipilimumab in recurrent SCLC. Results revealed that nivolumab monotherapy and the combination of nivolumab and ipilimumab were relatively safe and had antitumor activity. Pembrolizumab has been evaluated in a multicohort, phase 1b trial. Preliminary data showed a durable response in the second-line setting. Given the lack of overall survival data and significant toxicity associated with the combination of ipilimumab with first-line chemotherapy, this treatment is not a reasonable option at this time. Nivolumab alone or in combination with ipilimumab is a valid option for recurrent SCLC.

  11. Topotecan in the treatment of relapsed small cell lung cancer

    Directory of Open Access Journals (Sweden)

    Elisabeth Quoix

    2008-12-01

    Full Text Available Elisabeth QuoixService de Pneumologie, Hôpitaux Universitaires, Strasbourg, FranceAbstract: Small cell lung cancer (SCLC represents about 15% to 20% of all lung cancers. Chemotherapy is the cornerstone of the treatment, cisplatin–etoposide combination being the most used combination as first-line therapy. Despite high initial chemosensitivity, most SCLC patients will experience relapse sooner or later. Unfortunately, second-line chemotherapy does not result in a high response rate like first-line therapy, most patients having developed wide chemoresistance. This chemoresistance is far more important in refractory patients, ie, those who never responded to first-line therapy or who relapsed within 3 months after the end of chemotherapy, than in sensitive patients, ie, those who relapse more than 3 months after the end of chemotherapy. Topotecan, a topoisomerase I inhibitor, is the most studied drug in this second-line setting and has proved its efficacy as a single agent and in combination. A phase III trial comparing oral topotecan to best supportive care (BSC in relapsed SCLC demonstrated a significant survival benefit as well as a better quality of life. Although the usual schedule is 1.5 mg/m2, days 1–5 intravenously, it is not convenient for patients with relapsed SCLC, especially those who are refractory because of their short survival expectation. Oral topotecan is of similar efficacy and much more convenient with limited stay in a treatment unit and has a comparable toxicity profile for these patients with short expected survival. Combination of topotecan with platinum salts or taxanes does not seem to improve further the outcome of the patients and thus single-agent therapy with topotecan is the standard treatment for relapsed SCLC.Keywords: topotecan, small cell lung cancer, chemoresistance

  12. Oligometastatic non-small-cell lung cancer: current treatment strategies

    Directory of Open Access Journals (Sweden)

    Richard PJ

    2016-11-01

    Full Text Available Patrick J Richard, Ramesh Rengan Department of Radiation Oncology, University of Washington, Seattle, WA, USA Abstract: The oligometastatic disease theory was initially described in 1995 by Hellman and Weichselbaum. Since then, much work has been performed to investigate its existence in many solid tumors. This has led to subclassifications of stage IV cancer, which could redefine our treatment approaches and the therapeutic outcomes for this historically “incurable” entity. With a high incidence of stage IV disease, non-small-cell lung cancer (NSCLC remains a difficult cancer to treat and cure. Recent work has proven the existence of an oligometastatic state in NSCLC in terms of properly selecting patients who may benefit from aggressive therapy and experience long-term overall survival. This review discusses the current treatment approaches used in oligometastatic NSCLC and provides the evidence and rationale for each approach. The prognostic factors of many trials are discussed, which can be used to properly select patients for aggressive treatment regimens. Future advances in both molecular profiling of NSCLC to find targetable mutations and investigating patient selection may increase the number of patients diagnosed with oligometastatic NSCLC. As this disease entity increases, it is of utmost importance for oncologists treating NSCLC to be aware of the current treatment strategies that exist and the potential advantages/disadvantages of each. Keywords: oligometastatic, non-small-cell lung cancer, oligoprogressive, treatment

  13. The National Heart, Lung, and Blood Institute Small Business Program

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    Kurt W. Marek, PhD

    2016-12-01

    Full Text Available Small companies working to develop products in the cardiovascular space face numerous challenges, from regulatory, intellectual property, and reimbursement barriers to securing funds to keep the lights on and reach the next development milestone. Most small companies that spin out from universities have the scientific knowledge, but product development expertise and business acumen are also needed to be successful. Other challenges include reduced interest in early-stage technologies and limited deal flow for cardiovascular products. The National Heart, Lung, and Blood Institute (NHLBI small business program is a comprehensive ecosystem designed to address these critical challenges and to provide resources and expertise to assist early-stage companies developing cardiovascular and other products within the institute’s mission. This article describes steps that NHLBI has taken to enhance our small business program to more effectively translate basic discoveries into commercial products to benefit patients and public health, including enhancing internal expertise and developing nonfinancial resources to assist small businesses as they develop their products and seek private sector investment and partnership.

  14. Palliative Care Intervention in Improving Symptom Control and Quality of Life in Patients With Stage II-IV Non-small Cell Lung Cancer and Their Family Caregivers

    Science.gov (United States)

    2017-10-16

    Caregiver; Psychological Impact of Cancer and Its Treatment; Recurrent Non-small Cell Lung Cancer; Stage IIA Non-small Cell Lung Cancer; Stage IIB Non-small Cell Lung Cancer; Stage IIIA Non-small Cell Lung Cancer; Stage IIIB Non-small Cell Lung Cancer; Stage IV Non-small Cell Lung Cancer

  15. Approximations of noise covariance in multi-slice helical CT scans: impact on lung nodule size estimation.

    Science.gov (United States)

    Zeng, Rongping; Petrick, Nicholas; Gavrielides, Marios A; Myers, Kyle J

    2011-10-07

    Multi-slice computed tomography (MSCT) scanners have become popular volumetric imaging tools. Deterministic and random properties of the resulting CT scans have been studied in the literature. Due to the large number of voxels in the three-dimensional (3D) volumetric dataset, full characterization of the noise covariance in MSCT scans is difficult to tackle. However, as usage of such datasets for quantitative disease diagnosis grows, so does the importance of understanding the noise properties because of their effect on the accuracy of the clinical outcome. The goal of this work is to study noise covariance in the helical MSCT volumetric dataset. We explore possible approximations to the noise covariance matrix with reduced degrees of freedom, including voxel-based variance, one-dimensional (1D) correlation, two-dimensional (2D) in-plane correlation and the noise power spectrum (NPS). We further examine the effect of various noise covariance models on the accuracy of a prewhitening matched filter nodule size estimation strategy. Our simulation results suggest that the 1D longitudinal, 2D in-plane and NPS prewhitening approaches can improve the performance of nodule size estimation algorithms. When taking into account computational costs in determining noise characterizations, the NPS model may be the most efficient approximation to the MSCT noise covariance matrix.

  16. Volumetric measurements of pulmonary nodules at multi-row detector CT: in vivo reproducibility

    International Nuclear Information System (INIS)

    Wormanns, Dag; Marheine, Anke; Beyer, Florian; Heindel, Walter; Diederich, Stefan; Kohl, Gerhard; Klotz, Ernst

    2004-01-01

    The aim of this study was to assess the in vivo measurement precision of a software tool for volumetric analysis of pulmonary nodules from two consecutive low-dose multi-row detector CT scans. A total of 151 pulmonary nodules (diameter 2.2-20.5 mm, mean diameter 7.4±4.5 mm) in ten subjects with pulmonary metastases were examined with low-dose four-detector-row CT (120 kVp, 20 mAs (effective), collimation 4 x 1 mm, normalized pitch 1.75, slice thickness 1.25 mm, reconstruction increment 0.8 mm; Somatom VolumeZoom, Siemens). Two consecutive low-dose scans covering the whole lung were performed within 10 min. Nodule volume was determined for all pulmonary nodules visually detected in both scans using the volumetry tool included in the Siemens LungCare software. The 95% limits of agreement between nodule volume measurements on different scans were calculated using the Bland and Altman method for assessing measurement agreement. Intra- and interobserver agreement of volume measurement were determined using repetitive measurements of 50 randomly selected nodules at the same scan by the same and different observers. Taking into account all 151 nodules, 95% limits of agreement were -20.4 to 21.9% (standard error 1.5%); they were -19.3 to 20.4% (standard error 1.7%) for 105 nodules <10 mm. Limits of agreement were -3.9 to 5.7% for intraobserver and -5.5 to 6.6% for interobserver agreement. Precision of in vivo volumetric analysis of nodules with an automatic volumetry software tool was sufficiently high to allow for detection of clinically relevant growth in small pulmonary nodules. (orig.)

  17. Advances of Immunotherapy in Small Cell Lung Cancer

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    Jingjing LIU

    2014-06-01

    Full Text Available Small cell lung cancer (SCLC is complex heterogeneous due to unclear biological characteristics in terms of cell origin, pathogenesis and driver genes etc. Diagnosis and treatment of SCLC has been slowly improved and few breakthroughs have been discovered up to now. Therefore new strategies are urgently needed to improve the efficacy of SCLC treatment. Tumor immunotherapy has potential to restore and trigger the immune system to recognize and eliminate tumor cells, notably it has only minimal adverse impact on normal tissue. Cancer vaccine, adoptive immunotherapy, cytokines and checkpoint inhibitors have now been launched for clinical treatment of SCLC. Ipilimumab is the most promising medicine of immunotherapy. Immunotherapy is expected to bring new vision to the treatment of SCLC. And further researches are needed on such problems affecting efficacy of immunotherapy as the heterogeneity of SCLC, the uncertainty of target for immunotherapy, the immune tolerance, etc.

  18. Intercalated radio-chemotherapy in small cell lung cancer

    International Nuclear Information System (INIS)

    Hoskin, P.J.; Parton, D.; Yarnold, J.R.; Cherryman, G.; Smith, I.E.

    1991-01-01

    36 patients with small cell lung cancer have been treated using chemotherapy comprising carboplatin, ifosphamide and etoposide. A total of 6 cycles of chemotherapy was given. In 15 patients with limited disease intercalated radio-chemotherapy was used in which two 5-day courses of hyperfractionated radiotherapy were given to the thorax after the 1st and 2nd cycles of chemotherapy. Each course of thoracic radiotherapy delivered 15 Gy in 15 fractions over 5 days. Oesophagitis occurred in 7 patients (40 percent), in 5 of whom this was severe (WHO grade 3). Radiological pneumonitis developed in 6 patients (40 percent) with subsequent fibrosis in 2 patients. These effects are greater than would be expected with this dose of radiation alone and reflect marked enhancement of normal tissue toxicity. (author). 11 refs.; 1 fig.; 1 tab

  19. Nodule detection in digital chest radiography: Introduction to the radius chest trial

    International Nuclear Information System (INIS)

    Baath, M.; Haakansson, M.; Boerjesson, S.; Kheddache, S.; Grahn, A.; Ruschin, M.; Tingberg, A.; Mattsson, S.; Maansson, L. G.

    2005-01-01

    Most digital radiographic systems of today have wide latitude and are hence able to provide images with a small constraint on dose level. This opens up for an unprejudiced dose optimisation. However, in order to succeed in the optimisation task, good knowledge of the imaging and detection processes is needed. As a part of the European-wide research project 'unification of physical and clinical requirements for medical X-ray imaging - governed by the Radiological Imaging Unification Strategies (RADIUS) Group - a major image quality trial was conducted by members of the group. The RADIUS chest trial was focused on the detection of lung nodules in digital chest radiography with the aims of determining to what extent (1) the detection of a nodule is dependent on its location, (2) the system noise disturbs the detection of lung nodules, (3) the anatomical noise disturbs the detection of lung nodules and (4) the image background and anatomical background act as pure noise for the detection of lung nodules. The purpose of the present paper is to give an introduction to the trial and describe the framework and set-up of the investigation. (authors)

  20. Systemic Chemotherapy for Progression of Brain Metastases in Extensive-Stage Small Cell Lung Cancer

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    Nagla Abdel Karim

    2015-01-01

    Full Text Available Lung cancer is the most common cause of cancer related mortality in men and women. Approximately 15% of lung cancers are small cell type. Chemotherapy and radiation are the mainstay treatments. Currently, the standard chemotherapy regimen includes platinum/etoposide. For extensive small cell lung cancer, irinotecan and cisplatin have also been used. Patients with relapsed small cell lung cancer have a very poor prognosis, and the morbidity increases with brain metastases. Approximately 10%–14% of small cell lung cancer patients exhibit brain metastases at the time of diagnosis, which increases to 50%–80% as the disease progresses. Mean survival with brain metastases is reported to be less than six months, thus calling for improved regimens. Here we present a case series of patients treated with irinotecan for progressive brain metastases in small cell lung cancer, which serves as a reminder of the role of systemic chemotherapy in this setting.

  1. Non-invasive Characterization of the Histopathologic Features of Pulmonary Nodules of the Lung Adenocarcinoma Spectrum using Computer Aided Nodule Assessment and Risk Yield (CANARY) – a Pilot Study

    Science.gov (United States)

    Maldonado, Fabien; Boland, Jennifer M.; Raghunath, Sushravya; Aubry, Marie Christine; Bartholmai, Brian J.; deAndrade, Mariza; Hartman, Thomas E.; Karwoski, Ronald A.; Rajagopalan, Srinivasan; Sykes, Anne-Marie; Yang, Ping; Yi, Eunhee S.; Robb, Richard A.; Peikert, Tobias

    2013-01-01

    Introduction Pulmonary nodules of the adenocarcinoma spectrum are characterized by distinctive morphological and radiological features and variable prognosis. Non-invasive high-resolution computed-tomography (HRCT)-based risk stratification tools are needed to individualize their management. Methods Radiological measurements of histopathologic tissue invasion were developed in a training set of 54 pulmonary nodules of the adenocarcinoma spectrum and validated in 86 consecutively resected nodules. Nodules were isolated and characterized by computer-aided analysis and data were analyzed by Spearman correlation, sensitivity, specificity as well as the positive and negative predictive values. Results Computer Aided Nodule Assessment and Risk Yield (CANARY) can non-invasively characterize pulmonary nodules of the adenocarcinoma spectrum. Unsupervised clustering analysis of HRCT data identified 9 unique exemplars representing the basic radiologic building blocks of these lesions. The exemplar distribution within each nodule correlated well with the proportion of histologic tissue invasion, Spearman R=0.87,p < 0.0001 and 0.89,p < 0.0001 for the training and the validation set, respectively. Clustering of the exemplars in three-dimensional space corresponding to tissue invasion and lepidic growth was used to develop a CANARY decision algorithm, which successfully categorized these pulmonary nodules as “aggressive” (invasive adenocarcinoma) or “indolent” (adenocarcinoma in situ and minimally invasive adenocarcinoma). Sensitivity, specificity, positive predictive value and negative predictive value of this approach for the detection of “aggressive” lesions were 95.4%, 96.8%, 95.4% and 96.8%, respectively in the training set and 98.7%, 63.6%, 94.9% and 87.5%, respectively in the validation set. Conclusion CANARY represents a promising tool to non-invasively risk stratify pulmonary nodules of the adenocarcinoma spectrum. PMID:23486265

  2. Intratracheal Administration of Small Interfering RNA Targeting Fas Reduces Lung Ischemia-Reperfusion Injury.

    Science.gov (United States)

    Del Sorbo, Lorenzo; Costamagna, Andrea; Muraca, Giuseppe; Rotondo, Giuseppe; Civiletti, Federica; Vizio, Barbara; Bosco, Ornella; Martin Conte, Erica L; Frati, Giacomo; Delsedime, Luisa; Lupia, Enrico; Fanelli, Vito; Ranieri, V Marco

    2016-08-01

    Lung ischemia-reperfusion injury is the main cause of primary graft dysfunction after lung transplantation and results in increased morbidity and mortality. Fas-mediated apoptosis is one of the pathologic mechanisms involved in the development of ischemia-reperfusion injury. We hypothesized that the inhibition of Fas gene expression in lungs by intratracheal administration of small interfering RNA could reduce lung ischemia-reperfusion injury in an ex vivo model reproducing the procedural sequence of lung transplantation. Prospective, randomized, controlled experimental study. University research laboratory. C57/BL6 mice weighing 28-30 g. Ischemia-reperfusion injury was induced in lungs isolated from mice, 48 hours after treatment with intratracheal small interfering RNA targeting Fas, control small interfering RNA, or vehicle. Isolated lungs were exposed to 6 hours of cold ischemia (4°C), followed by 2 hours of warm (37°C) reperfusion with a solution containing 10% of fresh whole blood and mechanical ventilation with constant low driving pressure. Fas gene expression was significantly silenced at the level of messenger RNA and protein after ischemia-reperfusion in lungs treated with small interfering RNA targeting Fas compared with lungs treated with control small interfering RNA or vehicle. Silencing of Fas gene expression resulted in reduced edema formation (bronchoalveolar lavage protein concentration and lung histology) and improvement in lung compliance. These effects were associated with a significant reduction of pulmonary cell apoptosis of lungs treated with small interfering RNA targeting Fas, which did not affect cytokine release and neutrophil infiltration. Fas expression silencing in the lung by small interfering RNA is effective against ischemia-reperfusion injury. This approach represents a potential innovative strategy of organ preservation before lung transplantation.

  3. Diagnosis and management of solitary pulmonary nodules.

    Science.gov (United States)

    Jeong, Yeon Joo; Lee, Kyung Soo; Kwon, O Jung

    2008-12-01

    The advent of computed tomography (CT) screening with or without the help of computer-aided detection systems has increased the detection rate of solitary pulmonary nodules (SPNs), including that of early peripheral lung cancer. Helical dynamic (HD)CT, providing the information on morphologic and hemodynamic characteristics with high specificity and reasonably high accuracy, can be used for the initial assessment of SPNs. (18)F-fluorodeoxyglucose PET/CT is more sensitive at detecting malignancy than HDCT. Therefore, PET/CT may be selectively performed to characterize SPNs when HDCT gives an inconclusive diagnosis. Serial volume measurements are currently the most reliable methods for the tissue characterization of subcentimeter nodules. When malignant nodule is highly suspected for subcentimeter nodules, video-assisted thoracoscopic surgery nodule removal after nodule localization using the pulmonary nodule-marker system may be performed for diagnosis and treatment.

  4. Designing a new CAD system for pulmonary nodule detection in High Resolution Computed Tomography (HRCT images

    Directory of Open Access Journals (Sweden)

    Parsa Hosseini M

    2012-07-01

    Conclusion: Considering the complexity and different shapes of lung nodules and large number of CT images to evaluate, finding lung nodules are difficult and time consuming for physicians and include human error. Experimental results showed the accuracy of the proposed method to be appropriate (P<0.05 for lung nodule detection.

  5. Cetuximab and biomarkers in non-small-cell lung carcinoma

    Directory of Open Access Journals (Sweden)

    Patil N

    2012-07-01

    Full Text Available Nitin Patil, Mohammed Abba, Heike AllgayerDepartment of Experimental Surgery, Medical Faculty Mannheim, University of Heidelberg and Molecular Oncology of Solid Tumors Unit, German Cancer Research Center (DKFZ, Heidelberg, GermanyAbstract: Cancer progression is a highly complex process that is driven by a constellation of deregulated signaling pathways and key molecular events. In non-small-cell lung cancer (NSCLC, as in several other cancer types, the epidermal growth factor receptor (EGFR and its downstream signaling components represent a key axis that has been found not only to trigger cancer progression but also to support advanced disease leading to metastasis. Two major therapeutic approaches comprising monoclonal antibodies and small molecule tyrosine kinase inhibitors have so far been used to target this pathway, with a combination of positive, negative, and inconsequential results, as judged by patient survival indices. Since these drugs are expensive and not all patients derive benefits from taking them, it has become both pertinent and paramount to identify biomarkers that can predict not only beneficial response but also resistance. This review focuses on the chimeric monoclonal antibody, cetuximab, its application in the treatment of NSCLC, and the biomarkers that may guide its use in the clinical setting. A special emphasis is placed on the EGFR, including its structural and mechanistic attributes.Keywords: NSCLC, cetuximab, biomarker, cancer progression

  6. PDGFR-Β expression in small cell lung cancer patients

    International Nuclear Information System (INIS)

    Shinohara, Eric T.; Gonzalez, Adriana; Massion, Pierre P.; Olson, Sandra J.; Albert, Jeffrey M.; Shyr, Yu; Carbone, David P.; Johnson, David H.; Hallahan, Dennis E.; Lu Bo

    2007-01-01

    Background: Platelet derived growth factor (PDGF) and PDGFR-β are expressed and have been found to have prognostic value in several human cancers. Data in non-small-cell cancer cell lines have suggested that PDGFR is a therapeutic target for drug development. In the current study PDGFR-β expression and prognostic value in small cell lung cancer (SCLC) was investigated. Methods and Materials: Paraffin-embedded tissue blocks from 53 patients with limited and extensive stage SCLC were obtained for immunohistochemical staining. Tumors from each patient were sampled 3 times and stained with PDGFR-β specific antibody. Patients were divided into low and high staining groups based on intensity. Results: There was high intensity PDGFR-β staining in 20 patients with SCLC. Another 29 expressed low intensity PDGFR-β staining, with only 4 patients showing no PDGFR-β staining. There was no statistically significant difference in 5 year overall survival between patients with low levels of PDGFR-β staining vs. those with high level staining SCLC tumors (p = 0.538). Conclusions: The present study found that the majority of SCLC patients express, at least, a low level of PDGF-β. However, the level of PDGFR-β expression was not a statistically significant predictor of 5 year overall survival in SCLC

  7. [Principles of radiotherapy of non-small cell lung cancer].

    Science.gov (United States)

    Esik, Olga; Horváth, Akos; Bajcsay, András; Hideghéty, Katalin; Agócs, László; Pikó, Béla; Lengyel, Zsolt; Petrányi, Agota; Pisch, Julianna

    2002-01-01

    The long-term survival probability for Hungarian lung cancer patients is 10% worse than the best results published in the most highly developed countries (the mean 5-year survival probability in Hungary is 5%, in contrast with the 15% survival probability in the USA). On the basis of the international recommendations and personal experience, an attempt was made to formulate the guidelines for radiotherapy as one of the fundamental non-small cell lung cancer (NSCLC) treatment modalities for national use. An expert panel was set up comprising physicians from 6 radiotherapeutic centers (the National Institute of Oncology / Semmelweis University, Budapest; the Beth Israel Medical Center, New York; the University of Kaposvár; the University of Essen; the University of Debrecen; and the County Hospital of Gyula). Experts in two important medical fields closely related to radiotherapy (surgery and diagnostic imaging) were also engaged in the elaboration of the manuscript. Discussion of the most important principles of the radiotherapy and an overview of the prognostic factors was followed by a critical analysis of the protocols applied in the radiotherapy of Hungarian NSCLC patients during recent decades. The new guidelines suggested for the radiotherapy of NSCLC are presented separately for the postoperative period, marginally resectable tumors, and the aggressive or non-aggressive radiotherapy of inoperable tumors. Detailed accounts are given of the techniques of external irradiation and brachytherapy, and of the acute and late radiation-induced damage of normal tissues. The authors believe that this document may be instrumental in improving the survival index of Hungarian NSCLC patients in the near future.

  8. Treatment of Stage IV Non-small Cell Lung Cancer

    Science.gov (United States)

    Evans, Tracey; Gettinger, Scott; Hensing, Thomas A.; VanDam Sequist, Lecia; Ireland, Belinda; Stinchcombe, Thomas E.

    2013-01-01

    Background: Stage IV non-small cell lung cancer (NSCLC) is a treatable, but not curable, clinical entity in patients given the diagnosis at a time when their performance status (PS) remains good. Methods: A systematic literature review was performed to update the previous edition of the American College of Chest Physicians Lung Cancer Guidelines. Results: The use of pemetrexed should be restricted to patients with nonsquamous histology. Similarly, bevacizumab in combination with chemotherapy (and as continuation maintenance) should be restricted to patients with nonsquamous histology and an Eastern Cooperative Oncology Group (ECOG) PS of 0 to 1; however, the data now suggest it is safe to use in those patients with treated and controlled brain metastases. Data at this time are insufficient regarding the safety of bevacizumab in patients receiving therapeutic anticoagulation who have an ECOG PS of 2. The role of cetuximab added to chemotherapy remains uncertain and its routine use cannot be recommended. Epidermal growth factor receptor (EGFR) tyrosine kinase inhibitors as first-line therapy are the recommended treatment of those patients identified as having an EGFR mutation. The use of maintenance therapy with either pemetrexed or erlotinib should be considered after four cycles of first-line therapy in those patients without evidence of disease progression. The use of second- and third-line therapy in stage IV NSCLC is recommended in those patients retaining a good PS; however, the benefit of therapy beyond the third-line setting has not been demonstrated. In the elderly and in patients with a poor PS, the use of two-drug, platinum-based regimens is preferred. Palliative care should be initiated early in the course of therapy for stage IV NSCLC. Conclusions: Significant advances continue to be made, and the treatment of stage IV NSCLC has become nuanced and specific for particular histologic subtypes and clinical patient characteristics and according to the

  9. Granulomatous Bronchiolitis with Necrobiotic Pulmonary Nodules in Chrohn's Disease

    Directory of Open Access Journals (Sweden)

    Hugh J Freeman

    2004-01-01

    Full Text Available A 37-year-old man with extensive Crohn's disease of the stomach, small and large intestine for almost a decade developed respiratory symptoms and radiological findings suggestive of pneumonia that failed to resolve with antibiotic treatment. Computed tomography scanning of his lungs showed extensive changes with cavitated parenchymal nodules. Histological evaluation of an open lung biopsy showed granulomatous bronchiolitis and pulmonary necrobiosis. Treatment with steroids and immunosuppression resulted in complete resolution of his clinical symptoms of pneumonia and abnormal computed tomography imaging changes. Granulomatous bronchiolitis and necrobiotic nodules may be a manifestation of Crohn's disease in the absence of microbial agents, including mycobacteria or fungal agents. While a multiplicity of complex pulmonary changes may occur in Crohn's disease, their clinical recognition and precise pathological definition may be particularly important if treatment with a biological agent, such as infliximab, is being considered.

  10. Recent advances in the treatment of non-small cell and small cell lung cancer.

    Science.gov (United States)

    Stinchcombe, Thomas E

    2014-01-01

    Recent presentations at the American Society of Clinical Oncology (ASCO) meeting from 30 May to 3 June, 2014, will impact routine clinical care and the development of clinical trials in non-small cell lung cancer (NSCLC) and extensive stage small cell lung cancer (ES-SCLC). Patients with activating epidermal growth factor receptor (EGFR) mutations, defined as exon 19 and exon 21 L858R point mutations, experience a high objective response rate and prolonged progression-free survival with EGFR tyrosine kinase inhibitors. However, inevitably, patients experience disease progression and the most common mechanism of acquired resistance is an EGFR exon 20 T790M mutation. Several agents (AZD9291, CO-1686 and HM61713) have demonstrated impressive activity in patients with T790M resistance mutations. Additional data on the efficacy of first-line therapy with afatinib and the combination of erlotinib and bevacizumab for patients with EGFR mutant NSCLC were presented. The results of a phase III trial of crizotinib compared to platinum-pemetrexed in the first-line setting, and a phase I trial and expansion cohort of ceritinib, provided additional efficacy and toxicity data for patients with anaplastic lymphoma kinase rearranged NSCLC. A phase III trial of cisplatin and gemcitabine, with and without necitumumab, revealed an improvement in overall survival with the addition of necitumumab in patients with squamous NSCLC. In the second-line setting, a phase III trial of docetaxel with ramucirumab or placebo revealed an improvement in overall survival with the addition of ramucirumab. In extensive stage small cell lung cancer phase III trials of consolidative thoracic radiation therapy and prophylactic cranial radiation failed to reveal an improvement in overall survival.

  11. Improving the Diagnostic Specificity of CT for Early Detection of Lung Cancer: 4D CT-Based Pulmonary Nodule Elastometry

    Science.gov (United States)

    2015-10-01

    image registration investigation. Int J Radiat Oncol Biol Phys 2009;75:268–75. [13] Liu X, Saboo RR, Pizer SM , Mageras GS. A shape-navigated image...Larson SM , Arbit E. Characterization of neuroblastoma xenograft in rat flank. I. Growth, interstitial fluid pressure, and interstitial fluid velocity...al. Reduced lung-cancer mortality with low- dose computed tomographic screening. N Engl J Med 2011;365:395–409. [27] Maldonado F, Boland JM, Raghunath

  12. On the problem of roentgenological semiotics of small cell lung cancer

    International Nuclear Information System (INIS)

    Makarycheva, R.I.; Shchukina, O.P.; Gertner, K.; Vetrova, N.A.

    1985-01-01

    The study was concerned with description of roentgenologic semiotics of central and peripheral small cell lung cancer in 141 patients receiving chemoradiation therapy. The frequency of carcinoma metastatic spreading into intrathoracic lymph nodes was high. Small cell lung cancer showed a good response to conservative treatment, which, in particular, manifested itself in regression of metastases into intrathoracic lymph nodes

  13. Surgical management of non-small-cell lung cancer

    Directory of Open Access Journals (Sweden)

    Bamousa Ahmed

    2008-10-01

    Full Text Available Surgery plays a major role in the management of patients with lung cancer. Surgery is not only the main curative treatment modality in patients with early-stage lung cancer but it also has a significant role in the initial workup for the diagnosis and staging of lung cancer. This article describes the surgical management of patients with lung cancer. Surgical resection for lung cancer is still regarded as the most effective method for controlling the primary tumor, provided it is resectable for cure and the risks of the procedure are low. The 5-year survival rare following complete resection (R0 of a lung cancer is stage dependent [Table 1]. [1-3] Incomplete resection (R1, R2 rarely, if ever, cures the patient.

  14. Combination chemotherapy concurrent with small dose radiation therapy for small cell carcinoma of the lung

    International Nuclear Information System (INIS)

    Tada, Toshihiko; Fujita, Hiroji; Shintomi, Takenori

    1987-01-01

    Forty consecutive patients with small cell carcinoma of the lung were treated with chemotherapy, radiotherapy or both. Of 34 patients treated with chemotherapy, 24 were treated with combination chemotherapy, containing cyclophosphamide vincristine methotrexate and procarbazine, concurrent with small dose radiation therapy (500 cGy/5 fraction) as a chemosensitizer (COMPrt). The response rate to this regimen was 81 % (29 % complete) and the 2 year survival rate was 28.6 %. These results have been superior to other regimens and the toxicity was not see to be any higher. After completion of COMPrt regimen, 10 patients were treated with intrathoracic radiation therapy (average dose 3000 cGy) and 3 recieved surgical treatment. Radiation therapy improved the 2-year survival rate (42.2 %) when compared with those patients who received no radiation therapy (18.2 %). Three patients received surgical treatment were considered to be disease-free for 23, 17, and 9 months respectively, after induction of chemotherapy. (author)

  15. Cellular radiosensitivity of small-cell lung cancer cell lines

    International Nuclear Information System (INIS)

    Krarup, Marianne; Poulsen, Hans Skovgaard; Spang-Thomsen, Mogens

    1997-01-01

    Purpose: The objective of this study was to determine the radiobiological characteristics of a panel of small-cell lung cancer (SCLC) cell lines by use of a clonogenic assay. In addition, we tested whether comparable results could be obtained by employing a growth extrapolation method based on the construction of continuous exponential growth curves. Methods and Materials: Fifteen SCLC cell lines were studied, applying a slightly modified clonogenic assay and a growth extrapolation method. A dose-survival curve was obtained for each experiment and used for calculating several survival parameters. The multitarget single hit model was applied to calculate the cellular radiosensitivity (D 0 ), the capacity for sublethal damage repair (D q ), and the extrapolation number (n). Values for α and β were determined from best-fit curves according to the linear-quadratic model and these values were applied to calculate the surviving fraction after 2-Gy irradiation (SF 2 ). Results: In our investigation, the extrapolation method proved to be inappropriate for the study of in vitro cellular radiosensitivity due to lack of reproducibility. The results obtained by the clonogenic assay showed that the cell lines studied were radiobiologically heterogeneous with no discrete features of the examined parameters including the repair capacity. Conclusion: The results indicate that SCLC tumors per se are not generally candidates for hyperfractionated radiotherapy

  16. Prophylactic cranial irradiation in patients with small cell lung cancer

    DEFF Research Database (Denmark)

    Ramlov, Anne; Tietze, Anna; Khalil, Azza Ahmed

    2012-01-01

    BACKGROUND: Prophylactic cerebral irradiation (PCI) is a standard treatment for all small cell lung cancer (SCLC) patients with response to chemotherapy. The aims of this study were: to evaluate patients undergoing PCI with regard to cerebral recurrence rate, site of recurrence, and overall...... retrospectively with regard to disease stage, treatment, date of PCI, steroid dose during PCI, toxicity, time to recurrence, site of recurrence and time of death. The median follow up time was 16.6months (range 3-54months). RESULTS: Of the 118 patients undergoing PCI, 74 had limited disease (LD-SCLC) and 44 had...... extensive disease (ED-SCLC). The median age was 65years (range 46-80years). The median overall survival of all patients from the time of diagnosis was 16.0months (CI 95% 13.0-19.0), in LD-SCLC it was 24.0months (CI 95% 19.6-28.3), and in ED-SCLC it was 12.0months (CI 95% 9.6-14.4). Twenty-one patients (17...

  17. Cetuximab for treating non-small cell lung cancer.

    Science.gov (United States)

    Mazzarella, Luca; Guida, Alessandro; Curigliano, Giuseppe

    2018-04-01

    Epidermal Growth Factor Receptor (EGFR)-dependent signaling plays a crucial role in epithelial cancer biology, and dictated the development of several targeting agents. The mouse-human chimeric antibody Cetuximab was among the first to be developed. After about two decades of clinical research it has gained a significant place in the management of advanced colorectal and head and neck cancers, whereas its development in non small cell lung cancer (NSCLC) has not led to a place in routine clinical practice, because of marginal clinical benefit despite statistically significant Phase III trials. Recent data from ongoing trials suggest that more careful selection based on molecular markers may identify good responders. Areas covered: In this article, the authors review the literature concerning basic science studies identifying EGFR as a therapeutic target, pharmacological development of Cetuximab, its pharmacodynamics and pharmacokinetics, and clinical trials on Cetuximab in NSCLC, focusing on recent findings on putative predictive biomarkers. Expert opinion: Cetuximab currently has no role in NSCLC treatment outside of research settings. We argue that failure to identify a predictive biomarker early on has hampered its chances to enter routine practice. Although recent research suggests benefit in highly selected patient subsets, its potential impact is severely dampened by lack of regulatory body approval and the emergence of competitors for the same niches.

  18. Non small cell carcinoma of the lung: a retrospective study

    International Nuclear Information System (INIS)

    Stevens, G.; Firth, I.

    1992-01-01

    A retrospective study was undertaken in 1990 of 188 patients with the diagnosis of non small cell carcinoma of the lung referred to the Department of Radiation Oncology in 1984. Most patients (178 out of 188) received a course of radiotherapy. This was definitive in 23, palliative in 148 (primary site in 113, metastases in 16, primary plus metastases in 19) and postoperative in 7. This report is a 5 year follow-up of the 171 patients treated by radiation alone, to assess factors that influence survival. Palliative intent of treatment and poorer performance status were related significantly to increasing stage of disease. The effects of palliative treatment were recorded in 79 cases: in 71 there was a reduction in symptoms. The median survival from diagnosis was 8 months. Using univariate and multi-variate analyses, significant and independent prognostic factors for improved survival were good performance status, absence of systemic symptoms, lower tumour stage and curative intent of treatment (higher radiation dose). However the 5-year survival was only 2%. Long-term survival was associated predominantly with early stage disease but not with the type or intent of treatment. Age, sex, histology and apical site did not influence survival. These results are comparable to those found in the literature and emphasize the need to select patients carefully for either palliative or aggressive treatment. 29 refs., 4 tabs., 3 figs

  19. MEK inhibition in non-small cell lung cancer.

    Science.gov (United States)

    Stinchcombe, Thomas E; Johnson, Gary L

    2014-11-01

    KRAS mutations are the most common mutations in non-small cell lung cancer (NSCLC) with adenocarcinoma histology. KRAS mutations result in the activation of the RAF-MEK-ERK pathway, and agents that target RAF-MEK-ERK pathways have been investigated in KRAS mutant NSCLC. The two agents furthest in development are selumetinib and trametinib. Trametinib has greater binding for the MEK1/2 allosteric site, and generally has superior pharmacokinetics. A randomized phase II trial of docetaxel with and without selumetinib revealed that the combination resulted numerically superior overall survival, and a statistically significant improvement in progression-free survival and objective response rate. However, a concerning rate of hospital admission, grade 3 or 4 neutropenia, and febrile neutropenia was observed with the combination. Trials have investigated MEK inhibitors as single agents and in combination with erlotinib, and the data do not support the further development. The activity of MEK inhibitors appears to be similar in patients with KRAS mutant and wild-type NSCLC suggesting KRAS mutation status is not a reliable biomarker for efficacy. It is possible that mutations of genes in addition to KRAS mutations impact the activity of MEK inhibitors, or specific subsets of KRAS mutations may be resistant or susceptible to MEK inhibition. Other potential explanations are gene amplifications, alternative RNA splicing of genes resulting in activation of their protein products, and deregulation of noncoding RNAs and consequent altered protein expression. Copyright © 2014 Elsevier Ireland Ltd. All rights reserved.

  20. Refractory Lactic Acidosis in Small Cell Carcinoma of the Lung

    Directory of Open Access Journals (Sweden)

    Daniel J. Oh

    2017-01-01

    Full Text Available Background. Elevated lactate levels in critically ill patients are most often thought to be indicative of relative tissue hypoxia or type A lactic acidosis. Shock, severe anemia, and thromboembolic events can all cause elevated lactate due to tissue hypoperfusion, as well as the mitochondrial dysfunction thought to occur in sepsis and other critically ill states. Malignancy can also lead to elevation in lactate, a phenomenon described as type B lactic acidosis, which is much less commonly encountered in the critically ill. Case Presentation. We present the case of a 73-year-old Caucasian woman with type 2 diabetes and hypertension who presented with abdominal pain, nausea, vomiting, nonbloody diarrhea, and weight loss over five weeks and was found to have unexplained refractory lactic acidosis despite fluids and antibiotics. She was later diagnosed with small cell carcinoma of the lung. Conclusions. In this case report, we describe a critically ill patient whose elevated lactate was incorrectly attributed to her acute illness, when in truth it was an indicator of an underlying, as yet undiagnosed, malignancy. We believe this case is instructive to the critical care clinician as a reminder of the importance of considering malignancy on the differential diagnosis of a patient presenting with elevated lactate out of proportion to their critical illness.

  1. Lipidomic Profiling of Lung Pleural Effusion Identifies Unique Metabotype for EGFR Mutants in Non-Small Cell Lung Cancer

    OpenAIRE

    Ying Swan Ho; Lian Yee Yip; Nurhidayah Basri; Vivian Su Hui Chong; Chin Chye Teo; Eddy Tan; Kah Ling Lim; Gek San Tan; Xulei Yang; Si Yong Yeo; Mariko Si Yue Koh; Anantham Devanand; Angela Takano; Eng Huat Tan; Daniel Shao Weng Tan

    2016-01-01

    Cytology and histology forms the cornerstone for the diagnosis of non-small cell lung cancer (NSCLC) but obtaining sufficient tumour cells or tissue biopsies for these tests remains a challenge. We investigate the lipidome of lung pleural effusion (PE) for unique metabolic signatures to discriminate benign versus malignant PE and EGFR versus non-EGFR malignant subgroups to identify novel diagnostic markers that is independent of tumour cell availability. Using liquid chromatography mass spect...

  2. The incorporation of SPECT functional lung imaging into inverse radiotherapy planning for non-small cell lung cancer

    International Nuclear Information System (INIS)

    Christian, Judith A.; Partridge, Mike; Nioutsikou, Elena; Cook, Gary; McNair, Helen A.; Cronin, Bernadette; Courbon, Frederic; Bedford, James L.; Brada, Michael

    2005-01-01

    Background and purpose: Patients with non-small cell lung cancer (NSCLC) often have inhomogeneous lung perfusion. Radiotherapy planning computed tomography (CT) scans have been accurately co-registered with lung perfusion single photon emission computed tomography (SPECT) scans to design radiotherapy treatments which limit dose to healthy 'perfused' lung. Patients and methods: Patients with localised NSCLC had CT and SPECT scans accurately co-registered in the planning system. The SPECT images were used to define a volume of perfused 'functioning' lung (FL). Inverse planning software was used to create 3D-conformal plans, the planning objective being either to minimise the dose to whole lungs (WL) or to minimise the dose to FL. Results: Four plans were created for each of six patients. The mean difference in volume between WL and FL was 1011.7 cm 3 (range 596.2-1581.1 cm 3 ). One patient with bilateral upper lobe perfusion deficits had a 16% reduction in FLV 2 (the percentage volume of functioning lung receiving ≥20 Gy). The remaining patients had inhomogeneous perfusion deficits such that inverse planning was not able to sufficiently optimise beam angles to avoid functioning lung. Conclusion: SPECT perfusion images can be accurately co-registered with radiotherapy planning CT scans and may be helpful in creating treatment plans for patients with large perfusion deficits

  3. Validation of an elastic registration technique to estimate anatomical lung modification in Non-Small-Cell Lung Cancer Tomotherapy

    International Nuclear Information System (INIS)

    Faggiano, Elena; Cattaneo, Giovanni M; Ciavarro, Cristina; Dell'Oca, Italo; Persano, Diego; Calandrino, Riccardo; Rizzo, Giovanna

    2011-01-01

    The study of lung parenchyma anatomical modification is useful to estimate dose discrepancies during the radiation treatment of Non-Small-Cell Lung Cancer (NSCLC) patients. We propose and validate a method, based on free-form deformation and mutual information, to elastically register planning kVCT with daily MVCT images, to estimate lung parenchyma modification during Tomotherapy. We analyzed 15 registrations between the planning kVCT and 3 MVCT images for each of the 5 NSCLC patients. Image registration accuracy was evaluated by visual inspection and, quantitatively, by Correlation Coefficients (CC) and Target Registration Errors (TRE). Finally, a lung volume correspondence analysis was performed to specifically evaluate registration accuracy in lungs. Results showed that elastic registration was always satisfactory, both qualitatively and quantitatively: TRE after elastic registration (average value of 3.6 mm) remained comparable and often smaller than voxel resolution. Lung volume variations were well estimated by elastic registration (average volume and centroid errors of 1.78% and 0.87 mm, respectively). Our results demonstrate that this method is able to estimate lung deformations in thorax MVCT, with an accuracy within 3.6 mm comparable or smaller than the voxel dimension of the kVCT and MVCT images. It could be used to estimate lung parenchyma dose variations in thoracic Tomotherapy

  4. Immune-based Therapies for Non-small Cell Lung Cancer.

    Science.gov (United States)

    Rafei, Hind; El-Bahesh, Ehab; Finianos, Antoine; Nassereddine, Samah; Tabbara, Imad

    2017-02-01

    Lung cancer is the leading cause of cancer-related death worldwide. Treatment of non-small cell lung cancer has evolved tremendously over the past decade. Specifically, immune checkpoint inhibitors have become an increasingly interesting target of pharmacological blockade. These immune inhibitors have shown promising results in front-line therapy and after failure of multiple lines, as well as in monotherapy and combination with other therapies. Vaccination in non-small cell lung cancer is also an emerging field of research that holds promising results for the future of immunotherapy in non-small cell lung cancer. This review presents a concise update on the most recent data regarding the role of checkpoint inhibitors as well as vaccination in non-small cell lung cancer. Copyright© 2017, International Institute of Anticancer Research (Dr. George J. Delinasios), All rights reserved.

  5. An overview of mortality & predictors of small-cell and non-small cell lung cancer among Saudi patients

    Directory of Open Access Journals (Sweden)

    Hatim I. Alghamdi

    2018-03-01

    Full Text Available Lung cancer ranks as the top cancer worldwide in terms of incidence and constitutes a major health problem. About 90% of lung cancer cases are diagnosed at advance stage where treatment is not available. Despite evidence that lung cancer screening improves survival, guidelines for lung cancer screening are still a subject for debate. In Saudi Arabia, only 14% of lung cancers are diagnosed at early stage and researches on survival and its predictors are lacking. This overview analysis was conducted on predictors of lung cancer mortality according to the two major cancer types, small-cell lung cancers (SCLCs and non-small cell lung cancers (NSCLCs in Saudi Arabia. A secondary data analysis was performed on small-cell lung cancers (SCLCs and Non-small cell lung cancers (NSCLCs registered in the Saudi Cancer Registry (SCR for the period 2009–2013 to estimate predictors of mortality for both lung cancer types. A total of 404 cases (197 SCLC and 207 NSCLC were included in the analysis, all Saudi nationals. A total of 213 (52.75% deaths occurred among lung cancer patients, 108 (54.82% among SCLCs and 105 (50.72% among NCSLCs. Three quarter of patients are diagnosis with advance stage for both SCLC & NSCLC. Univariate analysis revealed higher mean age at diagnosis in dead patients compared to alive patients for SCLCs (p = 0.04; but not NSCLCs, a lower mortality for NSCLCs diagnosed in 2013 (p = 0.025 and a significant difference in stage of tumor (p = 0.006 and (p = 0.035 for both SCLC and NSCLC respectively. In multiple logistic regression, stage of tumor was a strong predictor of mortality, where distant metastasis increased morality by 6-fold (OR = 5.87, 95% CI: 2.01 – 17.19 in SCLC and by 3-fold (OR = 3.29, 95% CI: 1.22 – 8.85 in NSCLC, compared to localized tumors. Those with NSCLC who were diagnosed in 2013 were less likely to die by 64% compared to NSCLC diagnosed in 2009 (OR = 0.36, 95% CI: 0.14 – 0.93. Age, sex, topography

  6. An overview of mortality & predictors of small-cell and non-small cell lung cancer among Saudi patients.

    Science.gov (United States)

    Alghamdi, Hatim I; Alshehri, Ali F; Farhat, Ghada N

    2018-03-01

    Lung cancer ranks as the top cancer worldwide in terms of incidence and constitutes a major health problem. About 90% of lung cancer cases are diagnosed at advance stage where treatment is not available. Despite evidence that lung cancer screening improves survival, guidelines for lung cancer screening are still a subject for debate. In Saudi Arabia, only 14% of lung cancers are diagnosed at early stage and researches on survival and its predictors are lacking. This overview analysis was conducted on predictors of lung cancer mortality according to the two major cancer types, small-cell lung cancers (SCLCs) and non-small cell lung cancers (NSCLCs) in Saudi Arabia. A secondary data analysis was performed on small-cell lung cancers (SCLCs) and Non-small cell lung cancers (NSCLCs) registered in the Saudi Cancer Registry (SCR) for the period 2009-2013 to estimate predictors of mortality for both lung cancer types. A total of 404 cases (197 SCLC and 207 NSCLC) were included in the analysis, all Saudi nationals. A total of 213 (52.75%) deaths occurred among lung cancer patients, 108 (54.82%) among SCLCs and 105 (50.72%) among NCSLCs. Three quarter of patients are diagnosis with advance stage for both SCLC & NSCLC. Univariate analysis revealed higher mean age at diagnosis in dead patients compared to alive patients for SCLCs (p=0.04); but not NSCLCs, a lower mortality for NSCLCs diagnosed in 2013 (p=0.025) and a significant difference in stage of tumor (p=0.006) and (p=0.035) for both SCLC and NSCLC respectively. In multiple logistic regression, stage of tumor was a strong predictor of mortality, where distant metastasis increased morality by 6-fold (OR=5.87, 95% CI: 2.01 - 17.19) in SCLC and by 3-fold (OR=3.29, 95% CI: 1.22 - 8.85) in NSCLC, compared to localized tumors. Those with NSCLC who were diagnosed in 2013 were less likely to die by 64% compared to NSCLC diagnosed in 2009 (OR=0.36, 95% CI: 0.14 - 0.93). Age, sex, topography and laterality were not associated with

  7. VATS intraoperative tattooing to facilitate solitary pulmonary nodule resection

    Directory of Open Access Journals (Sweden)

    Boutros Cherif

    2008-03-01

    Full Text Available Abstract Introduction Video-assisted thoracic surgery (VATS has become routine and widely accepted for the removal of solitary pulmonary nodules of unknown etiology. Thoracosopic techniques continue to evolve with better instruments, robotic applications, and increased patient acceptance and awareness. Several techniques have been described to localize peripheral pulmonary nodules, including pre-operative CT-guided tattooing with methylene blue, CT scan guided spiral/hook wire placement, and transthoracic ultrasound. As pulmonary surgeons well know, the lung and visceral pleura may appear featureless on top of a pulmonary nodule. Case description This paper presents a rapid, direct and inexpensive approach to peripheral lung lesion resection by marking the lung parenchyma on top of the nodule using direct methylene blue injection. Methods In two patients with peripherally located lung nodules (n = 3 scheduled for VATS, we used direct methylene blue injection for intraoperative localization of the pulmonary nodule. Our technique was the following: After finger palpation of the lung, a spinal 25 gauge needle was inserted through an existing port and 0.1 ml of methylene blue was used to tattoo the pleura perpendicular to the localized nodule. The methylene blue tattoo immediately marks the lung surface over the nodule. The surgeon avoids repeated finger palpation, while lining up stapler, graspers and camera, because of the visible tattoo. Our technique eliminates regrasping and repalpating the lung once again to identify a non marked lesion. Results Three lung nodules were resected in two patients. Once each lesion was palpated it was marked, and the area was resected with security of accurate localization. All lung nodules were resected in totality with normal lung parenchymal margins. Our technique added about one minute to the operative time. The two patients were discharged home on the second postoperative day, with no morbidity. Conclusion

  8. Surgical management of oligometastatic non-small cell lung cancer.

    Science.gov (United States)

    Novoa, Nuria M; Varela, Gonzalo; Jiménez, Marcelo F

    2016-11-01

    The oligometastatic stage IV non-small cell lung cancer (NSCLC) offers a new surgical opportunity. New reported data is showing that surgery can offer a reasonable benefit, in terms of long-term survival, to some patients. The advantages of surgical treatment rely on a more adequate patient selection and a better understanding of the biology of these tumors. Currently, mediastinal involvement of the primary tumor can be identified as the most important prognostic variable after curative-intent of synchronous or metachronous metastasis. It seems clear that the routine use of combined FDG-PET and CT will help to detect the more favorable cohort of oligometastatic patients. As expected, pathological T staging of the primary tumor and the completeness of its resection are also crucial factors influencing final results. The real benefit of the local treatment over synchronous or metachronous metastasis is controversial with series showing better outcomes for metachronous lesions than for synchronous and others offering equal results. Also non conclusive results appear when analyzing different sites of metastasis. Retrospective series tend to show different outcomes depending on the affected organ while usually no differences are found in prospective ones. Most of the current evidence is based on retrospective studies on patients collected along extended periods of time. That represents a great limitation to the knowledge on this topic. Some prospective analyses have added some insight, but still the quality of the evidence is too low to allow drawing robust conclusions. As frequently concluded, prospective well designed investigation is requested to ascertain the value of surgery in this specific population of patients with extended NSCLC.

  9. Combination chemotherapy and radiotherapy of small cell lung cancer

    International Nuclear Information System (INIS)

    Saito, Yasuo; Chohtoh, Shuichi; Nishijima, Hiroshi; Kobayashi, Akihiko; Hirose, Jin-ichiro; Kamimura, Ryoichi; Takashima, Tsutomu; Konishi, Hideo; Miyata, Samon.

    1986-01-01

    Treatment results of 49 patients (25, limited disease, LD, 24, extensive disease, ED) with small cell lung cancer were retrospectively analyzed. Fifteen patients received chemotherapy with Cyclophosphamide (CPM) and Vincristine (VCR) following thoracic radiotherapy (RT). Twenty-two patients were given induction chemotherapy with CPM, Adriamycin (ADM), and VCR and were followed by thoracic RT. Other chemotherapy consisted of CPM, VCR, Methotrexate, and ADM in 2 patients, 5-FU, CPM, Mitomycin C, and Toyomycin in 1 patient. The remaining 9 patients (2, LD, 7, ED) were treated with RT alone. The response rate was 80 % (64 % CR; 16 % PR) for LD patients and 33 % (4 % CR; 29 % PR) for ED patients (P < 0.001). The three-year survival (Kaplan-Meier's product) of all patients was 14 %, with a median survival time (MST) of 8 months. For patients with LD, the 3-year survival was 27 % (MST 15 months). Survival of patients with ED was 14 % at 1 year, 0 % at 2 year (MST 5.5 months). The difference between these figures was statistically significant (P < 0.0003). The 3-year survival and relapse-free survival for complete responders with LD were 43 % (MST 21 months) and 36 % (median CR duration, 11.5 months) respectively. Six of 16 complete responders with LD are alive and well at over 2 years. Local recurrence rate of the complete responders with LD was 28.8 %. None of the 7 complete responders given more than 48 Gy relapsed within the radiation field. We believe that the addition of thoracic RT to patients with LD is necessary for the control of the primary tumors and for long-term disease-free survival. (author)

  10. Selectins mediate small cell lung cancer systemic metastasis.

    Directory of Open Access Journals (Sweden)

    Franziska Heidemann

    Full Text Available Metastasis formation is the major reason for the extremely poor prognosis in small cell lung cancer (SCLC patients. The molecular interaction partners regulating metastasis formation in SCLC are largely unidentified, however, from other tumor entities it is known that tumor cells use the adhesion molecules of the leukocyte adhesion cascade to attach to the endothelium at the site of the future metastasis. Using the human OH-1 SCLC line as a model, we found that these cells expressed E- and P-selectin binding sites, which could be in part attributed to the selectin binding carbohydrate motif sialyl Lewis A. In addition, protein backbones known to carry these glycotopes in other cell lines including PSGL-1, CD44 and CEA could be detected in in vitro and in vivo grown OH1 SCLC cells. By intravital microscopy of murine mesenterial vasculature we could capture SCLC cells while rolling along vessel walls demonstrating that SCLC cells mimic leukocyte rolling behavior in terms of selectin and selectin ligand interaction in vivo indicating that this mechanism might indeed be important for SCLC cells to seed distant metastases. Accordingly, formation of spontaneous distant metastases was reduced by 50% when OH-1 cells were xenografted into E-/P-selectin-deficient mice compared with wild type mice (p = 0.0181. However, as metastasis formation was not completely abrogated in selectin deficient mice, we concluded that this adhesion cascade is redundant and that other molecules of this cascade mediate metastasis formation as well. Using several of these adhesion molecules as interaction partners presumably make SCLC cells so highly metastatic.

  11. Crizotinib for Advanced Non-Small Cell Lung Cancer

    Science.gov (United States)

    A summary of results from an international phase III clinical trial that compared crizotinib versus chemotherapy in previously treated patients with advanced lung cancer whose tumors have an EML4-ALK fusion gene.

  12. Durvalumab: a potential maintenance therapy in surgery-ineligible non-small-cell lung cancer

    Directory of Open Access Journals (Sweden)

    Shafique MR

    2018-05-01

    Full Text Available Michael R Shafique, Lary A Robinson, Scott Antonia Department of Thoracic Oncology, H Lee Moffitt Cancer Center and Research Institute, Tampa, FL, USA Abstract: Lung cancer is the most common cancer worldwide and the most common cause of cancer-related death. Non-small-cell lung cancer comprises ~87% of newly diagnosed cases of lung cancer, and nearly one-third of these patients have stage III disease. Despite improvements in the treatment of stage IV lung cancer, particularly with the introduction and dissemination of checkpoint inhibitors, very little progress has been made in the treatment of stage III lung cancer. In this article, we discuss the general staging criteria and treatment options for stage III lung cancer. We review how concurrent radiation and chemotherapy can have immunomodulatory effects, supporting the rationale for incorporating immunotherapy into existing treatment paradigms. Finally, we discuss the results of the PACIFIC trial and implications for the treatment of stage III lung cancer. In the PACIFIC trial, adding durvalumab as a maintenance therapy following the completion of chemoradiotherapy improved progression-free survival in patients with locally advanced unresectable stage III lung cancer. On the strength of these results, durvalumab has been approved by the US Food and Drug Administration for use in this setting, representing the first advance in the treatment of stage III lung cancer in nearly a decade. Keywords: non-small-cell lung cancer, maintenance therapy, staging, immunotherapy, chemoradiation, surgery-ineligible, durvalumab

  13. 3D pulmonary nodules detection using fast marching segmentation ...

    African Journals Online (AJOL)

    This paper proposes an automated computer aided diagnosis system for detection of pulmonary nodules based on three dimensional (3D) structures. Lung ... The proposed detection methodology can give the accuracy of 92%. Keywords: lung cancer; pulmonary nodule; fast marching; 3D features; random forest classifier.

  14. Integrative genome analyses identify key somatic driver mutations of small-cell lung cancer

    NARCIS (Netherlands)

    Peifer, Martin; Fernandez-Cuesta, Lynnette; Sos, Martin L.; George, Julie; Seidel, Danila; Kasper, Lawryn H.; Plenker, Dennis; Leenders, Frauke; Sun, Ruping; Zander, Thomas; Menon, Roopika; Koker, Mirjam; Dahmen, Ilona; Mueller, Christian; Di Cerbo, Vincenzo; Schildhaus, Hans-Ulrich; Altmueller, Janine; Baessmann, Ingelore; Becker, Christian; de Wilde, Bram; Vandesompele, Jo; Boehm, Diana; Ansen, Sascha; Gabler, Franziska; Wilkening, Ines; Heynck, Stefanie; Heuckmann, Johannes M.; Lu, Xin; Carter, Scott L.; Cibulskis, Kristian; Banerji, Shantanu; Getz, Gad; Park, Kwon-Sik; Rauh, Daniel; Gruetter, Christian; Fischer, Matthias; Pasqualucci, Laura; Wright, Gavin; Wainer, Zoe; Russell, Prudence; Petersen, Iver; Chen, Yuan; Stoelben, Erich; Ludwig, Corinna; Schnabel, Philipp; Hoffmann, Hans; Muley, Thomas; Brockmann, Michael; Engel-Riedel, Walburga; Muscarella, Lucia A.; Fazio, Vito M.; Groen, Harry; Timens, Wim; Sietsma, Hannie; Thunnissen, Erik; Smit, Egbert; Heideman, Danielle A. M.; Snijders, Peter J. F.; Cappuzzo, Federico; Ligorio, Claudia; Damiani, Stefania; Field, John; Solberg, Steinar; Brustugun, Odd Terje; Lund-Iversen, Marius; Saenger, Joerg; Clement, Joachim H.; Soltermann, Alex; Moch, Holger; Weder, Walter; Solomon, Benjamin; Soria, Jean-Charles; Validire, Pierre; Besse, Benjamin; Brambilla, Elisabeth; Brambilla, Christian; Lantuejoul, Sylvie; Lorimier, Philippe; Schneider, Peter M.; Hallek, Michael; Pao, William; Meyerson, Matthew; Sage, Julien; Shendure, Jay; Schneider, Robert; Buettner, Reinhard; Wolf, Juergen; Nuernberg, Peter; Perner, Sven; Heukamp, Lukas C.; Brindle, Paul K.; Haas, Stefan; Thomas, Roman K.

    2012-01-01

    Small-cell lung cancer (SCLC) is an aggressive lung tumor subtype with poor prognosis(1-3). We sequenced 29 SCLC exomes, 2 genomes and 15 transcriptomes and found an extremely high mutation rate of 7.4 +/- 1 protein-changing mutations per million base pairs. Therefore, we conducted integrated

  15. Sarcomatoid Carcinoma of the lung: A rare case of three small intestinal intussusceptions and literature review

    Directory of Open Access Journals (Sweden)

    Angela Romano

    2015-01-01

    Conclusion: There are rare reports of small intestinal intussusceptions caused by metastatic lung carcinosarcoma, this presentation shows the third case in literature. Physicians should be more alert to symptoms or signs indicating GI metastais in patients with a history of lung cancer.

  16. Clinical applications of textural analysis in non-small cell lung cancer.

    Science.gov (United States)

    Phillips, Iain; Ajaz, Mazhar; Ezhil, Veni; Prakash, Vineet; Alobaidli, Sheaka; McQuaid, Sarah J; South, Christopher; Scuffham, James; Nisbet, Andrew; Evans, Philip

    2018-01-01

    Lung cancer is the leading cause of cancer mortality worldwide. Treatment pathways include regular cross-sectional imaging, generating large data sets which present intriguing possibilities for exploitation beyond standard visual interpretation. This additional data mining has been termed "radiomics" and includes semantic and agnostic approaches. Textural analysis (TA) is an example of the latter, and uses a range of mathematically derived features to describe an image or region of an image. Often TA is used to describe a suspected or known tumour. TA is an attractive tool as large existing image sets can be submitted to diverse techniques for data processing, presentation, interpretation and hypothesis testing with annotated clinical outcomes. There is a growing anthology of published data using different TA techniques to differentiate between benign and malignant lung nodules, differentiate tissue subtypes of lung cancer, prognosticate and predict outcome and treatment response, as well as predict treatment side effects and potentially aid radiotherapy planning. The aim of this systematic review is to summarize the current published data and understand the potential future role of TA in managing lung cancer.

  17. Identification of Gene Biomarkers for Distinguishing Small-Cell Lung Cancer from Non-Small-Cell Lung Cancer Using a Network-Based Approach

    Directory of Open Access Journals (Sweden)

    Fei Long

    2015-01-01

    Full Text Available Lung cancer consists of two main subtypes: small-cell lung cancer (SCLC and non-small-cell lung cancer (NSCLC that are classified according to their physiological phenotypes. In this study, we have developed a network-based approach to identify molecular biomarkers that can distinguish SCLC from NSCLC. By identifying positive and negative coexpression gene pairs in normal lung tissues, SCLC, or NSCLC samples and using functional association information from the STRING network, we first construct a lung cancer-specific gene association network. From the network, we obtain gene modules in which genes are highly functionally associated with each other and are either positively or negatively coexpressed in the three conditions. Then, we identify gene modules that not only are differentially expressed between cancer and normal samples, but also show distinctive expression patterns between SCLC and NSCLC. Finally, we select genes inside those modules with discriminating coexpression patterns between the two lung cancer subtypes and predict them as candidate biomarkers that are of diagnostic use.

  18. A novel panel of biomarkers in distinction of small well-differentiated HCC from dysplastic nodules and outcome values

    International Nuclear Information System (INIS)

    Jin, Guang-Zhi; Cong, Wen-Ming; Wu, Meng-Chao; Dong, Hui; Yu, Wen-Long; Li, Yan; Lu, Xin-Yuan; Yu, Hua; Xian, Zhi-Hong; Dong, Wei; Liu, Yin-Kun

    2013-01-01

    Differential diagnosis of high-grade dysplastic nodules (HGDN) and well-differentiated hepatocellular carcinoma (WDHCC) represents a challenge to experienced hepatic clinicians, radiologists and hepatopathologists. The expression profiles of aminoacylase-1 (ACY1), sequestosome-1 (SQSTM1) and glypican-3 (GPC3) in low-grade dysplastic nodules (LGDN), HGDN and WDHCC were assessed by immunohistochemistry. The differential diagnostic performances of these three markers alone and in combination for HGDN and WDHCC were investigated by logistic regression models (HGDN = 21; WDHCC = 32) and validated in an independent test set (HGDN, n = 21; WDHCC n = 24). Postoperative overall survival and time to recurrence were evaluated by univariate and multivariate analyses in an independent set of 500 patients. ACY1, SQSTM1 and GPC3 were differentially expressed in each group. For the differential diagnosis of WDHCC from HGDN, the sensitivity and specificity of the combination of ACY1 + SQSTM1 + GPC3 for detecting WDHCC were 93.8% and 95.2% respectively in the training set, which were higher than any of the three two-marker combinations. The validities of the four diagnostic models were further confirmed in an independent test set, and corresponding good sensitivity and specificity were observed. Interestingly, GPC3 expression in HCC tissues combined with serum α-fetoprotein (AFP) was found to be an independent predictor for overall survival and time to recurrence. ACY1 + SQSTM1 + GPC3 combination represents a potentially valuable biomarker for distinguishing between WDHCC and HGDN using immunohistochemistry. Meanwhile, low GPC3 staining combined with positive serum AFP may play a practical role in predicting poor postoperative outcome and high tumor recurrence risk

  19. Treatment of non-small-cell lung cancer in elderly patients

    International Nuclear Information System (INIS)

    Berzinec, P.

    2017-01-01

    Lung cancer is globally the leading cause of cancer-related deaths. Majority of lung cancer cases is diagnosed in elderly patients, aged ≥65 years. In Slovakia, 54% of new lung cancer cases are diagnosed in patients aged ≥65 years, and about 40% in patients aged ≥70 years. An experts panel created by EORTC (European Organisation for Research and Treatment of Cancer) and ISGO (International Society for Geriatric Oncology) published in 2014 updated recommendations for treatment of elderly patients with non-small-cell lung cancer. The brief overview of these recommendations, including a view of the new data published since 2014, is given in this article. (author)

  20. Consistent interactive segmentation of pulmonary ground glass nodules identified in CT studies

    Science.gov (United States)

    Zhang, Li; Fang, Ming; Naidich, David P.; Novak, Carol L.

    2004-05-01

    Ground glass nodules (GGNs) have proved especially problematic in lung cancer diagnosis, as despite frequently being malignant they characteristically have extremely slow rates of growth. This problem is further magnified by the small size of many of these lesions now being routinely detected following the introduction of multislice CT scanners capable of acquiring contiguous high resolution 1 to 1.25 mm sections throughout the thorax in a single breathhold period. Although segmentation of solid nodules can be used clinically to determine volume doubling times quantitatively, reliable methods for segmentation of pure ground glass nodules have yet to be introduced. Our purpose is to evaluate a newly developed computer-based segmentation method for rapid and reproducible measurements of pure ground glass nodules. 23 pure or mixed ground glass nodules were identified in a total of 8 patients by a radiologist and subsequently segmented by our computer-based method using Markov random field and shape analysis. The computer-based segmentation was initialized by a click point. Methodological consistency was assessed using the overlap ratio between 3 segmentations initialized by 3 different click points for each nodule. The 95% confidence interval on the mean of the overlap ratios proved to be [0.984, 0.998]. The computer-based method failed on two nodules that were difficult to segment even manually either due to especially low contrast or markedly irregular margins. While achieving consistent manual segmentation of ground glass nodules has proven problematic most often due to indistinct boundaries and interobserver variability, our proposed method introduces a powerful new tool for obtaining reproducible quantitative measurements of these lesions. It is our intention to further document the value of this approach with a still larger set of ground glass nodules.

  1. A comparison of conventional surfactant treatment and partial liquid ventilation on the lung volume of injured ventilated small lungs

    International Nuclear Information System (INIS)

    Proquitté, Hans; Hartenstein, Sebastian; Wauer, Roland R; Schmalisch, Gerd; Koelsch, Uwe; Rüdiger, Mario

    2013-01-01

    As an alternative to surfactant therapy (ST), partial liquid ventilation (PLV) with perfluorocarbons (PFC) has been considered as a treatment for acute lung injury (ALI) in newborns. The instilled PFC is much heavier than the instilled surfactant and the aim of this study was to investigate whether PLV, compared to ST, increases the end-expiratory volume of the lung (V L ). Fifteen newborn piglets (age <12 h, mean weight 678 g) underwent saline lung lavage to achieve a surfactant depletion. Thereafter animals were randomized to PLV (n = 8), receiving PFC PF5080 (3M, Germany) at 30 mL kg −1 , and ST (n = 7) receiving 120 mg Curosurf®. Blood gases, hemodynamics and static compliance were measured initially (baseline), immediately after ALI, and after 240 min mechanical ventilation with either technique. Subsequently all piglets were killed; the lungs were removed in toto and frozen in liquid N 2 . After freeze-drying the lungs were cut into lung cubes (LCs) with edge lengths of 0.7 cm, to calculate V L . All LCs were weighed and the density of the dried lung tissue was calculated. No statistically significant differences between treatment groups PLV and ST (means ± SD) were noted in body weight (676 ± 16 g versus 679 ± 17 g; P = 0.974) or lung dry weight (1.64 ± 0.29 g versus 1.79 ± 0.48 g; P = 0.48). Oxygenation index and ventilatory efficacy index did not differ significantly between both groups at any time. V L (34.28 ± 6.13 mL versus 26.22 ± 8.1 mL; P < 0.05) and the density of the dried lung tissue (48.07 ± 5.02 mg mL −1 versus 69.07 ± 5.30 mg mL −1 ; P < 0.001), however, differed significantly between the PLV and ST groups. A 4 h PLV treatment of injured ventilated small lungs increased V L by 30% and decreased lung density by 31% compared to ST treatment, indicating greater lung distension after PLV compared to ST. (paper)

  2. Genetic and Epigenetic Determinants of Lung Cancer Subtype: Adenocarcinoma to Small Cell Conversion

    Science.gov (United States)

    2016-10-01

    reported in other contexts including breast cancer and bladder cancer . While beyond the scope of this grant, and not funded by this mechanism, we...have participated in a recent collaborative analysis of common genomic alterations in small cell bladder cancer vs. small cell lung cancer . A paper...of the project is to study drug resistance mechanisms in vitro and using tumors from lung cancer patients with epidermal growth factor receptor

  3. Proton Beam Therapy for Non-Small Cell Lung Cancer: Current Clinical Evidence and Future Directions

    International Nuclear Information System (INIS)

    Berman, Abigail T.; James, Sara St.; Rengan, Ramesh

    2015-01-01

    Lung cancer is the leading cancer cause of death in the United States. Radiotherapy is an essential component of the definitive treatment of early-stage and locally-advanced lung cancer, and the palliative treatment of metastatic lung cancer. Proton beam therapy (PBT), through its characteristic Bragg peak, has the potential to decrease the toxicity of radiotherapy, and, subsequently improve the therapeutic ratio. Herein, we provide a primer on the physics of proton beam therapy for lung cancer, present the existing data in early-stage and locally-advanced non-small cell lung cancer (NSCLC), as well as in special situations such as re-irradiation and post-operative radiation therapy. We then present the technical challenges, such as anatomic changes and motion management, and future directions for PBT in lung cancer, including pencil beam scanning

  4. Current and future molecular diagnostics in non-small-cell lung cancer.

    Science.gov (United States)

    Li, Chun Man; Chu, Wing Ying; Wong, Di Lun; Tsang, Hin Fung; Tsui, Nancy Bo Yin; Chan, Charles Ming Lok; Xue, Vivian Wei Wen; Siu, Parco Ming Fai; Yung, Benjamin Yat Ming; Chan, Lawrence Wing Chi; Wong, Sze Chuen Cesar

    2015-01-01

    The molecular investigation of lung cancer has opened up an advanced area for the diagnosis and therapeutic management of lung cancer patients. Gene alterations in cancer initiation and progression provide not only information on molecular changes in lung cancer but also opportunities in advanced therapeutic regime by personalized targeted therapy. EGFR mutations and ALK rearrangement are important predictive biomarkers for the efficiency of tyrosine kinase inhibitor treatment in lung cancer patients. Moreover, epigenetic aberration and microRNA dysregulation are recent advances in the early detection and monitoring of lung cancer. Although a wide range of molecular tests are available, standardization and validation of assay protocols are essential for the quality of the test outcome. In this review, current and new advancements of molecular biomarkers for non-small-cell lung cancer will be discussed. Recommendations on future development of molecular diagnostic services will also be explored.

  5. Proton Beam Therapy for Non-Small Cell Lung Cancer: Current Clinical Evidence and Future Directions

    Directory of Open Access Journals (Sweden)

    Abigail T. Berman

    2015-07-01

    Full Text Available Lung cancer is the leading cancer cause of death in the United States. Radiotherapy is an essential component of the definitive treatment of early-stage and locally-advanced lung cancer, and the palliative treatment of metastatic lung cancer. Proton beam therapy (PBT, through its characteristic Bragg peak, has the potential to decrease the toxicity of radiotherapy, and, subsequently improve the therapeutic ratio. Herein, we provide a primer on the physics of proton beam therapy for lung cancer, present the existing data in early-stage and locally-advanced non-small cell lung cancer (NSCLC, as well as in special situations such as re-irradiation and post-operative radiation therapy. We then present the technical challenges, such as anatomic changes and motion management, and future directions for PBT in lung cancer, including pencil beam scanning.

  6. Presence of urokinase plasminogen activator, its inhibitor and receptor in small cell lung cancer and non-small cell lung cancer

    DEFF Research Database (Denmark)

    Pappot, H.; Pfeiffer, P.; Grøndahl Hansen, J.

    1997-01-01

    Spreading of cancer cells is dependent on the combined action of several proteolytic enzymes, such as serine proteases, comprising the urokinase pathway of plasminogen activation. Previous studies of lung cancer indicate that expression, localization and prognostic impact of the components...... of the plasminogen activation system differ in the different non-small cell lung cancer (NSCLC) types, whereas the expression of the components in small cell lung cancer (SCLC) has only sparingly been investigated. In the present study we investigate the presence of the components of the plasminogen activation...... that the plasminogen activation system could play a role in this type of cancer during invasion. In addition a difference in the levels of the components of the plasminogen activation system in NSCLC and SCLC is found, which could contribute to the differences in biology....

  7. Quantitative assessment of the influence of anatomic noise on the detection of subtle lung nodule in digital chest radiography using fractal-feature distance

    International Nuclear Information System (INIS)

    Imai, Kuniharu; Ikeda, Mitsuru; Enchi, Yukihiro; Niimi, Takanaga

    2008-01-01

    Purpose: To confirm whether or not the influence of anatomic noise on the detection of nodules in digital chest radiography can be evaluated by the fractal-feature distance. Materials and methods: We used the square images with and without a simulated nodule which were generated in our previous observer performance study; the simulated nodule was located on the upper margin of a rib, the inside of a rib, the lower margin of a rib, or the central region between two adjoining ribs. For the square chest images, fractal analysis was conducted using the virtual volume method. The fractal-feature distances between the considered and the reference images were calculated using the pseudo-fractal dimension and complexity, and the square images without the simulated nodule were employed as the reference images. We compared the fractal-feature distances with the observer's confidence level regarding the presence of a nodule in plain chest radiograph. Results: For all square chest images, the relationships between the length of the square boxes and the mean of the virtual volumes were linear on a log-log scale. For all types of the simulated nodules, the fractal-feature distance was the highest for the simulated nodules located on the central region between two adjoining ribs and was the lowest for those located in the inside of a rib. The fractal-feature distance showed a linear relation to an observer's confidence level. Conclusion: The fractal-feature distance would be useful for evaluating the influence of anatomic noise on the detection of nodules in digital chest radiography

  8. Preclinical evaluation of racotumomab, an anti-idiotype monoclonal antibody to N-glycolyl-containing gangliosides, with or without chemotherapy in a mouse model of non-small cell lung cancer

    International Nuclear Information System (INIS)

    Segatori, Valeria I.; Vazquez, Ana M.; Gomez, Daniel E.; Gabri, Mariano R.; Alonso, Daniel F.

    2012-01-01

    N-glycolylneuraminic acid (NeuGc) is a sialic acid molecule usually found in mammalian cells as terminal constituents of different membrane glycoconjugates such as gangliosides. The NeuGcGM3 ganglioside has been described as a tumor antigen for non-small cell lung cancer (NSCLC) in humans. Racotumomab is an anti-NeuGc-containing gangliosides anti-idiotype monoclonal antibody (mAb) (formerly known as 1E10) that has received attention as a potential active immunotherapy for advanced lung cancer in clinical trials. In this work, we have examined the antitumor activity of racotumomab in combination or not with chemotherapy, using the 3LL Lewis lung carcinoma as a preclinical model of NSCLC in C57BL/6 mice. Vaccination with biweekly doses of racotumomab at 50–200 μg/dose formulated in aluminum hydroxide (racotumomab-alum vaccine) demonstrated a significant antitumor effect against the progression of lung tumor nodules. Racotumomab-alum vaccination exerted a comparable effect on lung disease to that of pemetrexed-based chemotherapy (100 mg/kg weekly). Interestingly, chemo-immunotherapy was highly effective against lung nodules and well-tolerated, although no significant synergistic effect was observed as compared to each treatment alone in the present model. We also obtained evidence on the role of the exogenous incorporation of NeuGc in the metastatic potential of 3LL cells. Our preclinical data provide support for the combination of chemotherapy with the anti-idiotype mAb racotumomab, and also reinforce the biological significance of NeuGc in lung cancer.

  9. Preclinical evaluation of racotumomab, an anti-idiotype monoclonal antibody to N-glycolyl-containing gangliosides, with or without chemotherapy in a mouse model of non-small cell lung cancer

    Energy Technology Data Exchange (ETDEWEB)

    Segatori, Valeria I. [Laboratory of Molecular Oncology, Department of Science and Technology, Quilmes National University, Buenos Aires (Argentina); Vazquez, Ana M. [Center of Molecular Immunology, Innovation Managing Direction, La Habana (Cuba); Gomez, Daniel E.; Gabri, Mariano R.; Alonso, Daniel F., E-mail: dfalonso@unq.edu.ar [Laboratory of Molecular Oncology, Department of Science and Technology, Quilmes National University, Buenos Aires (Argentina)

    2012-11-08

    N-glycolylneuraminic acid (NeuGc) is a sialic acid molecule usually found in mammalian cells as terminal constituents of different membrane glycoconjugates such as gangliosides. The NeuGcGM3 ganglioside has been described as a tumor antigen for non-small cell lung cancer (NSCLC) in humans. Racotumomab is an anti-NeuGc-containing gangliosides anti-idiotype monoclonal antibody (mAb) (formerly known as 1E10) that has received attention as a potential active immunotherapy for advanced lung cancer in clinical trials. In this work, we have examined the antitumor activity of racotumomab in combination or not with chemotherapy, using the 3LL Lewis lung carcinoma as a preclinical model of NSCLC in C57BL/6 mice. Vaccination with biweekly doses of racotumomab at 50–200 μg/dose formulated in aluminum hydroxide (racotumomab-alum vaccine) demonstrated a significant antitumor effect against the progression of lung tumor nodules. Racotumomab-alum vaccination exerted a comparable effect on lung disease to that of pemetrexed-based chemotherapy (100 mg/kg weekly). Interestingly, chemo-immunotherapy was highly effective against lung nodules and well-tolerated, although no significant synergistic effect was observed as compared to each treatment alone in the present model. We also obtained evidence on the role of the exogenous incorporation of NeuGc in the metastatic potential of 3LL cells. Our preclinical data provide support for the combination of chemotherapy with the anti-idiotype mAb racotumomab, and also reinforce the biological significance of NeuGc in lung cancer.

  10. Validation of Interobserver Agreement in Lung Cancer Assessment: Hematoxylin-Eosin Diagnostic Reproducibility for Non–Small Cell Lung Cancer

    Science.gov (United States)

    Grilley-Olson, Juneko E.; Hayes, D. Neil; Moore, Dominic T.; Leslie, Kevin O.; Wilkerson, Matthew D.; Qaqish, Bahjat F.; Hayward, Michele C.; Cabanski, Christopher R.; Yin, Xiaoying; Socinski, Mark A.; Stinchcombe, Thomas E.; Thorne, Leigh B.; Allen, Timothy Craig; Banks, Peter M.; Beasley, Mary B.; Borczuk, Alain C.; Cagle, Philip T.; Christensen, Rebecca; Colby, Thomas V.; Deblois, Georgean G.; Elmberger, Göran; Graziano, Paolo; Hart, Craig F.; Jones, Kirk D.; Maia, Diane M.; Miller, C. Ryan; Nance, Keith V.; Travis, William D.; Funkhouser, William K.

    2018-01-01

    Context Precise subtype diagnosis of non–small cell lung carcinoma is increasingly relevant, based on the availability of subtype-specific therapies, such as bevacizumab and pemetrexed, and based on the subtype-specific prevalence of activating epidermal growth factor receptor mutations. Objectives To establish a baseline measure of inter-observer reproducibility for non–small cell lung carcinoma diagnoses with hematoxylin-eosin for the current 2004 World Health Organization classification, to estimate interobserver reproducibility for the therapeutically relevant squamous/nonsquamous subsets, and to examine characteristics that improve interobserver reproducibility. Design Primary, resected lung cancer specimens were converted to digital (virtual) slides. Based on a single hematoxylin-eosin virtual slide, pathologists were asked to assign a diagnosis using the 2004 World Health Organization classification. Kappa statistics were calculated for each pathologist-pair for each slide and were summarized by classification scheme, pulmonary pathology expertise, diagnostic confidence, and neoplastic grade. Results The 12 pulmonary pathology experts and the 12 community pathologists each independently diagnosed 48 to 96 single hematoxylin-eosin digital slides derived from 96 cases of non–small cell lung carcinoma resection. Overall agreement improved with simplification from the comprehensive 44 World Health Organization diagnoses (κ = 0.25) to their 10 major header subtypes (κ = 0.48) and improved again with simplification into the therapeutically relevant squamous/nonsquamous dichotomy (κ = 0.55). Multivariate analysis showed that higher diagnostic agreement was associated with better differentiation, better slide quality, higher diagnostic confidence, similar years of pathology experience, and pulmonary pathology expertise. Conclusions These data define the baseline diagnostic agreement for hematoxylin-eosin diagnosis of non–small cell lung carcinoma

  11. New data for venous thromboembolism in patients with small cell lung cancer: A review.

    Science.gov (United States)

    Dimakakos, Evangelos; Livanios, Konstantinos; Gkiozos, Ioannis; Charpidou, Adriani; Ntalakou, Eleutheria; Kainis, Llias; Syrigos, Konstantinos

    2017-01-01

    Malignancy is an important predisposing factor for thromboembolic disease. Patients with malignancy display 4 to 10 times greater risk than the general population. As for lung cancer, that risk seems to further increase and become up to 20 times higher. The aim of this article is to review the International literature in order to highlight for the first time, the correlation between thromboembolic disease and small cell lung cancer. PubMed, Medline and Embase databases were searched from 1990 up to 2016, for retrospective and prospective studies that investigate the correlation between thromboembolic disease and small cell lung cancer. The incidence rate of thromboembolic disease found in these studies ranged between 6.8% and 11.5%. Thromboembolic disease is associated with a reduced survival in patients with small cell lung cancer and six factors seemed to increase the risk of thromboembolism: chemotherapy, cisplatin treatment, smoking, extensive disease, the infiltration of the superior vena cava and multiple concomitant diseases. Thromboembolic disease shows an increased incidence in patients with small cell lung cancer and more research with well-designed studies is required in order to study in detail the anticoagulation treatment and the survival in small cell lung cancer patients.

  12. Evaluation of pentavalent Tc-99m DMSA scintigraphy in small cell and nonsmall cell lung cancers

    International Nuclear Information System (INIS)

    Atasever, T.; Guendogdu, C.; Vural, G.; Kapucu, L.Oe.; Karalezli, A.; Uenlue, M.

    1997-01-01

    Aim: The purpose of this study was to evaluate the clinical usefulness of Tc-99m (V) DMSA in patients suspected of lung cancer and determine whether this agent may have value in differentiation between small cell (SCLC) and non-small cell (NSCLC) lung carcinoma. Methods: Thirty-six patients with clinical and radiological suspicion of primary lung carcinoma were injected 450-600 MBq of Tc-99m (V) DMSA intravenously. Whole body and planar anterior, posterior thorax images were obtained 4-5 h after injection of the radioactive complex. Results: Histopathological results confirmed 23 NSCLC, 10 SCLC and 1 metastatic lung carcinoma and 2 lung abscess. Nineteen of the 23 (82%) NSCLC and all of the 10 (100%) SCLC cases showed Tc-99m (V) DMSA uptake. Single metastatic lung cancer also accumulated radiotracer. Lung abscess did not show uptake. Lesion/Nonlesion (L/N) ratio of SCLC (1.59±0.32) and NSCLC (1.43±0.19) tumour types did not show statistical difference (p>0.05). Tc-99m (V) DMSA whole body imaging also showed bone metastases. Conclusion: Tc-99m (V) DMSA is a noninvasive and cheap imaging method to detect malignant lung cancers and their bone metastases but, differentiation of SCLC and NSCLC is not possible. (orig.) [de

  13. Molecular biologic study about the non-small cell lung carcinoma (2) : p53 gene alteration in non-small cell lung carcinoma

    International Nuclear Information System (INIS)

    Park, Jong Ho; Zo, Jae Ill; Paik, Hee Jong; Kim, Mi Hee

    1996-12-01

    The main purpose of this research was to identify of the p53 and 3p gene alteration in non-small cell lung cancer patients residing in Korea. Furthermore, we analyzed the relationship between the p53 and 3p gene alterations and the clinicopathologic results of lung cancer patients. And we have investigated the role of PCR-LOH in analyzing tumor samples for LOH of defined chromosomal loci. We have used the 40 samples obtained from the lung cancer patients who were diagnosed and operated curatively at Korea Cancer Center Hospital. We have isolated the high molecular weight. DNA from the tumors and normal tissues. And we have amplified the DNA with PCR method and used the microsatellite assay method to detect the altered p53 and 3p gene. The conclusions were as follow: 1) The 3p gene alteration was observed in 9/39 (23.1%) and p53 gene alteration was observed in 15/40 (37.5%) of resected non-small cell lung cancer. 2) There was no correlations between the 3p or p53 gene alterations and prognosis of patients, but further study is necessary. 3) PCR-LOH is a very useful tool for analyzing small amount of tumor samples for loss of heterozygosity of defined chromosomal loci. (author). 10 refs

  14. Radiosensitization of non-small cell lung cancer by kaempferol.

    Science.gov (United States)

    Kuo, Wei-Ting; Tsai, Yuan-Chung; Wu, His-Chin; Ho, Yung-Jen; Chen, Yueh-Sheng; Yao, Chen-Han; Yao, Chun-Hsu

    2015-11-01

    The aim of the present study was to determine whether kaempferol has a radiosensitization potential for lung cancer in vitro and in vivo. The in vitro radio-sensitization activity of kaempferol was elucidated in A-549 lung cancer cells by using an MTT (3-(4 5-dimethylthiazol-2-yl)-25-diphenyl-tetrazolium bromide) assay, cell cycle analysis and clonogenic assay. The in vivo activity was evaluated in the BALB/c nude mouse xenograft model of A-549 cells by hematoxylin and eosin staining and immunohistochemistry, and the tumor volume was recorded. Protein levels of the apoptotic pathway were detected by western blot analysis. Treatment with kaempferol inhibited the growth of A-549 cells through activation of apoptotic pathway. However, the same doses did not affect HFL1 normal lung cell growth. Kaempferol induced G2/M cell cycle arrest and the enhancement of radiation-induced death and clonogenic survival inhibition. The in vivo data showed that kaempferol increased tumor cell apoptosis and killing of radiation. In conclusion, the findings demonstrated that kaempferol increased tumor cell killing by radiation in vitro and in vivo through inhibition of the AKT/PI3K and ERK pathways and activation of the mitochondria apoptosis pathway. The results of the present study provided solid evidence that kaempferol is a safe and potential radiosensitizer.

  15. Lung cancer-associated tumor antigens and the present status of immunotherapy against non-small-cell lung cancer

    International Nuclear Information System (INIS)

    Yasumoto, Kosei; Hanagiri, Takeshi; Takenoyama, Mitsuhiro

    2009-01-01

    Despite recent advances in surgery, irradiation, and chemotherapy, the prognosis of patients with lung cancer is still poor. Therefore, the development and application of new therapeutic strategies are essential for improving the prognosis of this disease. Significant progress in our understanding of tumor immunology and molecular biology has allowed us to identify the tumor-associated antigens recognized by cytotoxic T lymphocytes. Immune responses and tumor-associated antigens against not only malignant melanoma but also lung cancer have been elucidated at the molecular level. In a theoretical sense, tumor eradication is considered possible through antigen-based immunotherapy against such diseases. However, many clinical trials of cancer vaccination with defined tumor antigens have resulted in objective clinical responses in only a small number of patients. Tumor escape mechanisms from host immune surveillance remain a major obstacle for cancer immunotherapy. A better understanding of the immune escape mechanisms employed by tumor cells is necessary before we can develop a more effective immunotherapeutic approach to lung cancer. We review recent studies regarding the identification of tumor antigens in lung cancer, tumor immune escape mechanisms, and clinical vaccine trials in lung cancer. (author)

  16. Melittin exerts an antitumor effect on non‑small cell lung cancer cells.

    Science.gov (United States)

    Zhang, Su-Fang; Chen, Zhe

    2017-09-01

    Lung cancer accounts for a significant percentage of all cancer‑associated mortalities in men and women, with non‑small cell lung cancer being the most frequently occurring type of lung cancer. Melittin is the principal active component of apitoxin (bee venom) that has been reported to exert anti‑chronic inflammatory and anti‑cancer effects. In the present study, the antitumor effect of melittin was evaluated using in vivo and in vitro analyses. The results demonstrated that melittin significantly inhibited the epidermal growth factor‑induced invasion and migration of non‑small cell lung cancer cells. Subcutaneous injection of melittin at doses of 1 and 10 mg/kg significantly suppressed non‑small cell lung cancer tumor growth by 27 and 61%, respectively. In addition, melittin significantly inhibited the secretion of vascular endothelial growth factor (VEGF) in non‑small cell lung cancer cells. Furthermore, melittin decreased the protein expression of VEGF and hypoxia‑inducible factor 1‑α. Therefore, the antitumor activity of melittin may be associated with the anti‑angiogenic actions of inhibiting the VEGF and hypoxia‑inducible factor signaling pathways.

  17. CXCR4/CXCL12 in Non-Small-Cell Lung Cancer Metastasis to the Brain

    Directory of Open Access Journals (Sweden)

    Sebastiano Cavallaro

    2013-01-01

    Full Text Available Lung cancer represents the leading cause of cancer-related mortality throughout the world. Patients die of local progression, disseminated disease, or both. At least one third of the people with lung cancer develop brain metastases at some point during their disease, even often before the diagnosis of lung cancer is made. The high rate of brain metastasis makes lung cancer the most common type of tumor to spread to the brain. It is critical to understand the biologic basis of brain metastases to develop novel diagnostic and therapeutic approaches. This review will focus on the emerging data supporting the involvement of the chemokine CXCL12 and its receptor CXCR4 in the brain metastatic evolution of non-small-cell lung cancer (NSCLC and the pharmacological tools that may be used to interfere with this signaling axis.

  18. Elective brain irradiation in patients with small-cell carcinoma of the lung: preliminary report

    International Nuclear Information System (INIS)

    Katsenis, A.T.; Karpasitis, N.; Giannakakis, D.; Maragoudakis, N.; Kiparissiadis, P.

    1982-01-01

    The brain is a common site of metastases in small-cell carcinoma of the lung. Prophylactic brain irradiation with doses of 4000-4500 rads in 3-4 weeks appears to decrease the occurrence of brain metastases although it does not prevent this completely. In a group of patients with small-cell carcinoma of the lung and without evidence of brain metastases, the authors review the site and extent of the primary, the methods of treatment, the techniques of brain irradiation, and the relapses rate in relation to the status of the primary and the rate of brain metastases in another group without prophylactic brain irradiation. They further attempt to investigate combined modalities of treatment which would prolong life and prevent neurological complications in the small number of long survivors with small-cell carcinoma of the lung. (Auth.)

  19. Changes in epidermal growth factor receptor expression during chemotherapy in non-small cell lung cancer

    DEFF Research Database (Denmark)

    Jakobsen, Jan Nyrop; Santoni-Rugiu, Eric; Sørensen, Jens Benn

    2014-01-01

    BACKGROUND: Antibodies targeting epidermal growth factor receptor (EGFR), such as cetuximab, may potentially improve outcome in non-small cell lung cancer (NSCLC) patients with high EGFR expression. The EGFR expression may be heterogeneously distributed within tumors, and small biopsies may thus...

  20. Dosimetric verification of small fields in the lung using lung-equivalent polymer gel and Monte Carlo simulation.

    Science.gov (United States)

    Gharehaghaji, Nahideh; Dadgar, Habib Alah

    2018-01-01

    The main purpose of this study was evaluate a polymer-gel-dosimeter (PGD) for three-dimensional verification of dose distributions in the lung that is called lung-equivalent gel (LEG) and then to compare its result with Monte Carlo (MC) method. In the present study, to achieve a lung density for PGD, gel is beaten until foam is obtained, and then sodium dodecyl sulfate is added as a surfactant to increase the surface tension of the gel. The foam gel was irradiated with 1 cm × 1 cm field size in the 6 MV photon beams of ONCOR SIEMENS LINAC, along the central axis of the gel. The LEG was then scanned on a 1.5 Tesla magnetic resonance imaging scanner after irradiation using a multiple-spin echo sequence. Least-square fitting the pixel values from 32 consecutive images using a single exponential decay function derived the R2 relaxation rates. Moreover, 6 and 18 MV photon beams of ONCOR SIEMENS LINAC are simulated using MCNPX MC Code. The MC model is used to calculate the depth dose water and low-density water resembling the soft tissue and lung, respectively. Percentages of dose reduction in the lung region relative to homogeneous phantom for 6 MV photon beam were 44.6%, 39%, 13%, and 7% for 0.5 cm × 0.5 cm, 1 cm × 1 cm, 2 cm × 2 cm, and 3 cm × 3 cm fields, respectively. For 18 MV photon beam, the results were found to be 82%, 69%, 46%, and 25.8% for the same field sizes, respectively. Preliminary results show good agreement between depth dose measured with the LEG and the depth dose calculated using MCNP code. Our study showed that the dose reduction with small fields in the lung was very high. Thus, inaccurate prediction of absorbed dose inside the lung and also lung/soft-tissue interfaces with small photon beams may lead to critical consequences for treatment outcome.

  1. Small cell lung cancer with metastasis to the thyroid in a patient with toxic multinodular goiter.

    Science.gov (United States)

    Ozgu, Eylem Sercan; Gen, Ramazan; Ilvan, Ahmet; Ozge, Cengiz; Polat, Ayşe; Vayisoglu, Yusuf

    2012-11-01

    Thyroid metastasis of lung cancer is rarely observed in clinical practice. The primary cancers which metastasize to the thyroid gland are mostly renal cell carcinoma, lung cancer, and breast cancer. Transient destructive thyrotoxicosis is caused by massive metastasis of extrathyroid tumors. We herein present a case report of a patient with small cell carcinoma of lung with metastasis to the thyroid and thyrotoxicosis due to toxic multinodular goiter. A 66-year-old man complained of swelling around the right side of the neck, dyspnea, progressive weight loss, and palpitation starting since 3 months before his admission. The patient was diagnosed with small cell carcinoma of lung with metastasis to the thyroid and thyrotoxicosis due to toxic multinodular goiter. The case report presented here illustrates the challenge of making a definitive and adequate diagnosis, particularly if the patient presents with 2 potential causes of thyrotoxicosis. Thyroid scintigraphy is an important tool for differential diagnosis of thyrotoxicosis.

  2. Clinical and radiological characteristics of central pulmonary adenocarcinoma: a comparison with central squamous cell carcinoma and small cell lung cancer and the impact on treatment response

    Directory of Open Access Journals (Sweden)

    Wang Z

    2018-05-01

    Full Text Available Zhe Wang,1,2 Minghuan Li,2 Yong Huang,3 Li Ma,3 Hui Zhu,2 Li Kong,2 Jinming Yu2 1School of Medicine, Shandong University, Jinan, Shandong, China; 2Department of Radiation Oncology, Shandong Cancer Hospital Affiliated to Shandong University, Jinan, Shandong, China; 3Department of Radiology, Shandong Cancer Hospital Affiliated to Shandong University, Jinan, Shandong, China Purpose: The proportion of central pulmonary adenocarcinoma (ADC in central-type lung cancer has been gradually increasing due to the overall increasing incidence of pulmonary ADC. But the clinical and radiological characteristics of central ADCs remain unclear. In this study, we compared the clinical and radiological characteristics of central ADCs with those of small cell lung cancers (SCLCs and squamous cell carcinomas (SQCCs and investigated the impact of these characteristics on patients’ treatment response. Patients and methods: The medical records of 302 consecutive patients with central lung cancer from July 2014 to September 2016 were retrospectively reviewed. There were 99 patients with ADC, 95 with SQCC and 108 with SCLC. Computed tomography images were interpreted by two radiologists. Treatment response was determined by Response Evaluation Criteria In Solid Tumors 1.1. Results: Univariate analyses found that younger age, female sex, no history of smoking, higher levels of carcinoembryonic antigen (CEA, contralateral hilum lymphadenopathy, contralateral lung metastasis, pleural nodules and pleural metastasis to the interlobular fissure were significantly correlated with central ADC. Multivariate logistic regression analyses revealed that compared with central SQCC, female sex, younger age, no history of smoking, higher levels of CEA and contralateral hilum lymphadenopathy were the significantly independent indicators of central pulmonary ADC. Furthermore, compared with central SCLC, younger age, higher levels of CEA and cytokeratin 19 fragment (Cyfra21-1, lower

  3. Small Molecular TRAIL Inducer ONC201 Induces Death in Lung Cancer Cells: A Preclinical Study

    OpenAIRE

    Feng, Yuan; Zhou, Jihong; Li, Zhanhua; Jiang, Ying; Zhou, Ying

    2016-01-01

    Tumor necrosis factor (TNF)-related apoptosis-inducing ligand (TRAIL) selectively targets cancer cells. The present preclinical study investigated the anti-cancer efficiency of ONC201, a first-in-class small molecule TRAIL inducer, in lung cancer cells. We showed that ONC201 was cytotoxic and anti-proliferative in both established (A549 and H460 lines) and primary human lung cancer cells. It was yet non-cytotoxic to normal lung epithelial cells. Further, ONC201 induced exogenous apoptosis act...

  4. Superior Vena Cava Syndrome in a Patient with Small-Cell Lung Cancer: A Case Report

    OpenAIRE

    Christina Brzezniak; Bryan Oronsky; Corey A. Carter; Bennett Thilagar; Scott Caroen; Karen Zeman

    2017-01-01

    Superior vena cava (SVC) syndrome, a potential oncologic emergency, is closely associated with malignancy and right-sided lung cancer in particular. A case of SVC syndrome presenting with facial swelling, neck distension, and enlarged veins of the upper chest, which developed over a period of 5 weeks in a 46-year-old patient on a clinical trial with small-cell lung cancer, is reported. Computed tomography scan of the chest revealed slight enlargement of a superior conglomerate mediastinal lym...

  5. Proton beam therapy in non-small cell lung cancer: state of the art

    Directory of Open Access Journals (Sweden)

    Harada H

    2017-08-01

    Full Text Available Hideyuki Harada, Shigeyuki Murayama Radiation and Proton Therapy Center, Shizuoka Cancer Center Hospital, Nagaizumi, Shizuoka, Japan Abstract: This review summarizes the past and present status of proton beam therapy (PBT for lung cancer. PBT has a unique characteristic called the Bragg peak that enables a reduction in the dose of normal tissue around the tumor, but is sensitive to the uncertainties of density changes. The heterogeneity in electron density for thoracic lesions, such as those in the lung and mediastinum, and tumor movement according to respiration necessitates respiratory management for PBT to be applied in lung cancer patients. There are two types of PBT – a passively scattered approach and a scanning approach. Typically, a passively scattered approach is more robust for respiratory movement and a scanning approach could result in a more conformal dose distribution even when the tumor shape is complex. Large tumors of centrally located lung cancer may be more suitably irradiated than with intensity-modulated radiotherapy (IMRT or stereotactic body radiotherapy (SBRT. For a locally advanced lung cancer, PBT can spare the lung and heart more than photon IMRT. However, no randomized controlled trial has reported differences between PBT and IMRT or SBRT for early-stage and locally advanced lung cancers. Therefore, a well-designed controlled trial is warranted. Keywords: proton beam therapy, non-small cell lung cancer, survival, SBRT, IMRT

  6. Does advanced lung inflammation index (ALI) have prognostic significance in metastatic non-small cell lung cancer?

    Science.gov (United States)

    Ozyurek, Berna Akinci; Ozdemirel, Tugce Sahin; Ozden, Sertac Buyukyaylaci; Erdoğan, Yurdanur; Ozmen, Ozlem; Kaplan, Bekir; Kaplan, Tugba

    2018-01-22

    Lung cancer is the most commonly diagnosed and death-related cancer type and is more frequent in males. Non-small-cell lung cancer (NSCLC) accounts for about 85% of all case. In this study, it was aimed to research the relationship between advanced lung inflammation index (ALI) and the primary mass maximum standardized uptake value (SUVmax) and C-reactive protein (CRP) at initial diagnosis and the prognostic value of ALI in determining the survival in metastatic NSCLC. A total of 112 patients diagnosed as stage 4 non-small-lung cancer in our hospital between January 2006 and December 2013 were included in this study. ALI was calculated as body mass index (BMI) × serum albumin/neutrophil-to-lymphocyte ratio (NLR). The patients were divided into two groups as ALI ALI ≥ 18 (low inflammation). The log-rank test and Cox proportional hazard model were used to identify predictors of mortality. Evaluation was made of 94 male and 18 female patients with a mean age of 59.7 ± 9.9 years. A statistically significant negative relationship was determined between ALI and CRP values (P ALI and SUVmax values (P = .436). The median survival time in patients with ALI ALI ≥ 18, it was 16 months (P = .095). ALI is an easily calculated indicator of inflammation in lung cancer patients. Values <18 can be considered to predict a poor prognosis. © 2018 John Wiley & Sons Ltd.

  7. The safety and efficacy of carboplatin plus nanoparticle albumin-bound paclitaxel in the treatment of non-small cell lung cancer patients with interstitial lung disease.

    Science.gov (United States)

    Yasuda, Yuichiro; Hattori, Yoshihiro; Tohnai, Rie; Ito, Shoichi; Kawa, Yoshitaka; Kono, Yuko; Urata, Yoshiko; Nogami, Munenobu; Takenaka, Daisuke; Negoro, Shunichi; Satouchi, Miyako

    2018-01-01

    The optimal chemotherapy regimen for non-small cell lung cancer patients with interstitial lung disease is unclear. We therefore investigated the safety and efficacy of carboplatin plus nab-paclitaxel as a first-line regimen for non-small cell lung cancer in patients with interstitial lung disease. We retrospectively reviewed advanced non-small cell lung cancer patients with interstitial lung disease who received carboplatin plus nab-paclitaxel as a first-line chemotherapy regimen at Hyogo Cancer Center between February 2013 and August 2016. interstitial lung disease was diagnosed according to the findings of pretreatment chest high-resolution computed tomography. Twelve patients were included (male, n = 11; female, n = 1). The overall response rate was 67% and the disease control rate was 100%. The median progression free survival was 5.1 months (95% CI: 2.9-8.3 months) and the median overall survival was 14.9 months (95% CI: 4.8-not reached). A chemotherapy-related acute exacerbation of interstitial lung disease was observed in one patient; the extent of this event was Grade 2. There were no treatment-related deaths. Carboplatin plus nab-paclitaxel, as a first-line chemotherapy regimen for non-small cell lung cancer, showed favorable efficacy and safety in patients with preexisting interstitial lung disease. © The Author 2017. Published by Oxford University Press. All rights reserved. For permissions, please e-mail: journals.permissions@oup.com

  8. Lipopolysaccharide does not alter small airway reactivity in mouse lung slices.

    Science.gov (United States)

    Donovan, Chantal; Royce, Simon G; Vlahos, Ross; Bourke, Jane E

    2015-01-01

    The bacterial endotoxin, lipopolysaccharide (LPS) has been associated with occupational airway diseases with asthma-like symptoms and in acute exacerbations of COPD. The direct and indirect effects of LPS on small airway reactivity have not been fully elucidated. We tested the hypothesis that both in vitro and in vivo LPS treatment would increase contraction and impair relaxation of mouse small airways. Lung slices were prepared from naïve Balb/C mice and cultured in the absence or presence of LPS (10 μg/ml) for up to 48 h for measurement of TNFα levels in conditioned media. Alternatively, mice were challenged with PBS or LPS in vivo once a day for 4 days for preparation of lung slices or for harvest of lungs for Q-PCR analysis of gene expression of pro-inflammatory cytokines and receptors involved in airway contraction. Reactivity of small airways to contractile agonists, methacholine and serotonin, and bronchodilator agents, salbutamol, isoprenaline and rosiglitazone, were assessed using phase-contrast microscopy. In vitro LPS treatment of slices increased TNFα release 6-fold but did not alter contraction or relaxation to any agonists tested. In vivo LPS treatment increased lung gene expression of TNFα, IL-1β and ryanodine receptor isoform 2 more than 5-fold. However there were no changes in reactivity in lung slices from these mice, even when also incubated with LPS ex vivo. Despite evidence of LPS-induced inflammation, neither airway hyperresponsiveness or impaired dilator reactivity were evident. The increase in ryanodine receptor isoform 2, known to regulate calcium signaling in vascular smooth muscle, warrants investigation. Since LPS failed to elicit changes in small airway reactivity in mouse lung slices following in vitro or in vivo treatment, alternative approaches are required to define the potential contribution of this endotoxin to altered small airway reactivity in human lung diseases.

  9. Lipopolysaccharide does not alter small airway reactivity in mouse lung slices.

    Directory of Open Access Journals (Sweden)

    Chantal Donovan

    Full Text Available The bacterial endotoxin, lipopolysaccharide (LPS has been associated with occupational airway diseases with asthma-like symptoms and in acute exacerbations of COPD. The direct and indirect effects of LPS on small airway reactivity have not been fully elucidated. We tested the hypothesis that both in vitro and in vivo LPS treatment would increase contraction and impair relaxation of mouse small airways. Lung slices were prepared from naïve Balb/C mice and cultured in the absence or presence of LPS (10 μg/ml for up to 48 h for measurement of TNFα levels in conditioned media. Alternatively, mice were challenged with PBS or LPS in vivo once a day for 4 days for preparation of lung slices or for harvest of lungs for Q-PCR analysis of gene expression of pro-inflammatory cytokines and receptors involved in airway contraction. Reactivity of small airways to contractile agonists, methacholine and serotonin, and bronchodilator agents, salbutamol, isoprenaline and rosiglitazone, were assessed using phase-contrast microscopy. In vitro LPS treatment of slices increased TNFα release 6-fold but did not alter contraction or relaxation to any agonists tested. In vivo LPS treatment increased lung gene expression of TNFα, IL-1β and ryanodine receptor isoform 2 more than 5-fold. However there were no changes in reactivity in lung slices from these mice, even when also incubated with LPS ex vivo. Despite evidence of LPS-induced inflammation, neither airway hyperresponsiveness or impaired dilator reactivity were evident. The increase in ryanodine receptor isoform 2, known to regulate calcium signaling in vascular smooth muscle, warrants investigation. Since LPS failed to elicit changes in small airway reactivity in mouse lung slices following in vitro or in vivo treatment, alternative approaches are required to define the potential contribution of this endotoxin to altered small airway reactivity in human lung diseases.

  10. Percutaneous thermal ablation for stage IA non-small cell lung cancer: long-term follow-up.

    Science.gov (United States)

    Narsule, Chaitan K; Sridhar, Praveen; Nair, Divya; Gupta, Avneesh; Oommen, Roy G; Ebright, Michael I; Litle, Virginia R; Fernando, Hiran C

    2017-10-01

    Surgical resection is the most effective curative therapy for non-small cell lung cancer (NSCLC). However, many patients are unable to tolerate resection secondary to poor reserve or comorbid disease. Radiofrequency ablation (RFA) and microwave ablation (MWA) are methods of percutaneous thermal ablation that can be used to treat medically inoperable patients with NSCLC. We present long-term outcomes following thermal ablation of stage IA NSCLC from a single center. Patients with stage IA NSCLC and factors precluding resection who underwent RFA or MWA from July 2005 to September 2009 were studied. CT and PET-CT scans were performed at 3 and 6 month intervals, respectively, for first 24 months of follow-up. Factors associated with local progression (LP) and overall survival (OS) were analyzed. Twenty-one patients underwent 21 RFA and 4 MWA for a total of 25 ablations. Fifteen patients had T1a and six patients had T1b tumors. Mean follow-up was 42 months, median survival was 39 months, and OS at three years was 52%. There was no significant difference in median survival between T1a nodules and T1b nodules (36 vs . 39 months, P=0.29) or for RFA and MWA (36 vs . 50 months, P=0.80). Ten patients had LP (47.6%), at a median time of 35 months. There was no significant difference in LP between T1a and T1b tumors (22 vs . 35 months, P=0.94) or RFA and MWA (35 vs . 17 months, P=0.18). Median OS with LP was 32 months compared to 39 months without LP (P=0.68). Three patients underwent repeat ablations. Mean time to LP following repeat ablation was 14.75 months. One patient had two repeat ablations and was disease free at 40-month follow-up. Thermal ablation effectively treated or controlled stage IA NSCLC in medically inoperable patients. Three-year OS exceeded 50%, and LP did not affect OS. Therefore, thermal ablation is a viable option for medically inoperable patients with early stage NSCLC.

  11. Effective avoidance of a functional spect-perfused lung using intensity modulated radiotherapy (IMRT) for non-small cell lung cancer (NSCLC): An update of a planning study

    International Nuclear Information System (INIS)

    Lavrenkov, Konstantin; Singh, Shalini; Christian, Judith A.; Partridge, Mike; Nioutsikou, Elena; Cook, Gary; Bedford, James L.; Brada, Michael

    2009-01-01

    IMRT and 3-dimensional conformal radiotherapy (3-DCRT) plans of 25 patients with non-small cell lung (NSCLC) were compared in terms of planning target volume (PTV) coverage and sparing of functional lung (FL) defined by a SPECT perfusion scan. IMRT resulted in significant reduction of functional V 20 and mean lung dose in stage III patients with inhomogeneous hypoperfusion. If the dose to FL is shown to be the determinant of lung toxicity, IMRT would allow for effective dose escalation by specific avoidance of functional lung.

  12. The clinical application of percutaneous auto-biopsy of small lung nodular under CT-Guided

    International Nuclear Information System (INIS)

    Zhou Yuanmin; Ye Genxin; Zhang Chenghui; Wang Yu; Chen Wei

    2008-01-01

    Objective: To evaluated the clinical value of technology of petcutaneous auto-biopsy of small lung nodular under CT- Guide. Methods: 44 cases of small single lung nodular were underwent biopsy with 20G auto-biopsy needle under CT guidance. All cases underwent pathological diagnosis. Results: All 44 cases were punctured successfully. 41 cases were succeeded in first puncturation. The success ratio was 93.02%. Other 3 cases needed second puncturation. 39 of 44 cases pathological diagnosis were malignant. Only 1 case could not be diagnosed. 6 patients had lightly pneumatothorax after biopsy. 10 cases had mild pneumonorrhagia after biopsy. 2 of them had haemptysis. All cases had no complication such as infection, needle track implantation. Conclusion: The technology of CT Guidance auto-biopsy of small lung nodular is safe and effective; it has extreme diagnostic ratio and less complication. (authors)

  13. Toward precision medicine with next-generation EGFR inhibitors in non-small-cell lung cancer

    Directory of Open Access Journals (Sweden)

    Yap TA

    2014-09-01

    Full Text Available Timothy A Yap,1,2 Sanjay Popat1,3 1Lung Cancer Unit, Department of Medicine, The Royal Marsden National Health Service Foundation Trust, London, United Kingdom; 2The Institute of Cancer Research, London, United Kingdom; 3National Heart and Lung Institute, London, United Kingdom Abstract: The use of genomics to discover novel targets and biomarkers has placed the field of oncology at the forefront of precision medicine. First-generation epidermal growth factor receptor (EGFR inhibitors have transformed the therapeutic landscape of EGFR mutant non-small-cell lung carcinoma through the genetic stratification of tumors from patients with this disease. Somatic EGFR mutations in lung adenocarcinoma are now well established as predictive biomarkers of response and resistance to small-molecule EGFR inhibitors. Despite early patient benefit, primary resistance and subsequent tumor progression to first-generation EGFR inhibitors are seen in 10%–30% of patients with EGFR mutant non-small-cell lung carcinoma. Acquired drug resistance is also inevitable, with patients developing disease progression after only 10–13 months of antitumor therapy. This review details strategies pursued in circumventing T790M-mediated drug resistance to EGFR inhibitors, which is the most common mechanism of acquired resistance, and focuses on the clinical development of second-generation EGFR inhibitors, exemplified by afatinib (BIBW2992. We discuss the rationale, mechanism of action, clinical efficacy, and toxicity profile of afatinib, including the LUX-Lung studies. We also discuss the emergence of third-generation irreversible mutant-selective inhibitors of EGFR and envision the future management of EGFR mutant lung adenocarcinoma. Keywords: afatinib, EGFR, erlotinib, gefitinib, LUX-Lung, NSCLC 

  14. Lung cancer

    International Nuclear Information System (INIS)

    Aisner, J.

    1985-01-01

    This book contains 13 chapters. Some of the chapter titles are: The Pathology of Lung Cancer; Radiotherapy for Non-Small-Cell Cancer of the Lung; Chemotherapy for Non-Small-Cell Lung Cancer; Immunotherapy in the Management of Lung Cancer; Preoperative Staging and Surgery for Non-Small-Cell Lung Cancer; and Prognostic Factors in Lung Cancer

  15. Metabolic and hemodynamic evaluation of brain metastases from small cell lung cancer with positron emission tomography

    DEFF Research Database (Denmark)

    Lassen, U; Andersen, P; Daugaard, G

    1998-01-01

    for studies of metabolic and hemodynamic features. This study was performed to determine regional cerebral metabolic rate of glucose (rCMRglu), regional cerebral blood flow (rCBF), and regional cerebral blood volume (rCBV) in brain metastases from small cell lung cancer and the surrounding brain. Tumor r......Brain metastases from small cell lung cancer respond to chemotherapy, but response duration is short and the intracerebral concentration of chemotherapy may be too low because of the characteristics of the blood-brain barrier. Positron emission tomography has been applied in a variety of tumors...

  16. Transbronchial lung biopsy with a flexible cryoprobe: First case report from India

    Directory of Open Access Journals (Sweden)

    Sahajal Dhooria

    2016-01-01

    Full Text Available Sarcoidosis and tuberculosis are granulomatous disorders that mimic each other both clinically and radiologically. Both can present with fever and pulmonary nodules and often require the performance of transbronchial lung biopsy (TBLB for diagnosis. In recent studies, the flexible cryoprobe for carrying out TBLB has been found to be useful in the diagnosis of disorders diffusely involving the lung parenchyma. Here, we present the case of a 29-year-old man who presented with fever and cough and was found to have multiple small nodules in both lungs. TBLB with a flexible cryoprobe helped in differentiating between sarcoidosis and tuberculosis.

  17. Radiofrequency ablation in primary non-small cell lung cancer: What a radiologist needs to know

    Science.gov (United States)

    Bhatia, Shivank; Pereira, Keith; Mohan, Prasoon; Narayanan, Govindarajan; Wangpaichitr, Medhi; Savaraj, Niramol

    2016-01-01

    Lung cancer continues to be one of the leading causes of death worldwide. In advanced cases of lung cancer, a multimodality approach is often applied, however with poor local control rates. In early non-small cell lung cancer (NSCLC), surgery is the standard of care. Only 15-30% of patients are eligible for surgical resection. Improvements in imaging and treatment delivery systems have provided new tools to better target these tumors. Stereotactic body radiation therapy (SBRT) has evolved as the next best option. The role of radiofrequency ablation (RFA) is also growing. Currently, it is a third-line option in stage 1 NSCLC, when SBRT cannot be performed. More recent studies have demonstrated usefulness in recurrent tumors and some authors have also suggested combination of RFA with other modalities in larger tumors. Following the National Lung Screening Trial (NLST), screening by low-dose computed tomography (CT) has demonstrated high rates of early-stage lung cancer detection in high-risk populations. Hence, even considering the current role of RFA as a third-line option, in view of increasing numbers of occurrences detected, the number of potential RFA candidates may see a steep uptrend. In view of all this, it is imperative that interventional radiologists be familiar with the techniques of lung ablation. The aim of this article is to discuss the procedural technique of RFA in the lung and review the current evidence regarding RFA for NSCLC. PMID:27081229

  18. Small Molecular TRAIL Inducer ONC201 Induces Death in Lung Cancer Cells: A Preclinical Study.

    Science.gov (United States)

    Feng, Yuan; Zhou, Jihong; Li, Zhanhua; Jiang, Ying; Zhou, Ying

    2016-01-01

    Tumor necrosis factor (TNF)-related apoptosis-inducing ligand (TRAIL) selectively targets cancer cells. The present preclinical study investigated the anti-cancer efficiency of ONC201, a first-in-class small molecule TRAIL inducer, in lung cancer cells. We showed that ONC201 was cytotoxic and anti-proliferative in both established (A549 and H460 lines) and primary human lung cancer cells. It was yet non-cytotoxic to normal lung epithelial cells. Further, ONC201 induced exogenous apoptosis activation in lung cancer cells, which was evidenced by TRAIL/death receptor-5 (DR5) induction and caspase-8 activation. The caspase-8 inhibitor or TRAIL/DR5 siRNA knockdown alleviated ONC201's cytotoxicity against lung cancer cells. Molecularly, ONC201 in-activated Akt-S6K1 and Erk signalings in lung cancer cells, causing Foxo3a nuclear translocation. For the in vivo studies, intraperitoneal injection of ONC201 at well-tolerated doses significantly inhibited xenografted A549 tumor growth in severe combined immunodeficient (SCID) mice. Further, ONC201 administration induced TRAIL/DR5 expression, yet inactivated Akt-S6K1 and Erk in tumor tissues. These results of the study demonstrates the potent anti-lung cancer activity by ONC201.

  19. Small Molecular TRAIL Inducer ONC201 Induces Death in Lung Cancer Cells: A Preclinical Study.

    Directory of Open Access Journals (Sweden)

    Yuan Feng

    Full Text Available Tumor necrosis factor (TNF-related apoptosis-inducing ligand (TRAIL selectively targets cancer cells. The present preclinical study investigated the anti-cancer efficiency of ONC201, a first-in-class small molecule TRAIL inducer, in lung cancer cells. We showed that ONC201 was cytotoxic and anti-proliferative in both established (A549 and H460 lines and primary human lung cancer cells. It was yet non-cytotoxic to normal lung epithelial cells. Further, ONC201 induced exogenous apoptosis activation in lung cancer cells, which was evidenced by TRAIL/death receptor-5 (DR5 induction and caspase-8 activation. The caspase-8 inhibitor or TRAIL/DR5 siRNA knockdown alleviated ONC201's cytotoxicity against lung cancer cells. Molecularly, ONC201 in-activated Akt-S6K1 and Erk signalings in lung cancer cells, causing Foxo3a nuclear translocation. For the in vivo studies, intraperitoneal injection of ONC201 at well-tolerated doses significantly inhibited xenografted A549 tumor growth in severe combined immunodeficient (SCID mice. Further, ONC201 administration induced TRAIL/DR5 expression, yet inactivated Akt-S6K1 and Erk in tumor tissues. These results of the study demonstrates the potent anti-lung cancer activity by ONC201.

  20. Loss of expression of BAP1 is very rare in non-small cell lung carcinoma.

    Science.gov (United States)

    Andrici, Juliana; Parkhill, Thomas R; Jung, Jason; Wardell, Kathryn L; Verdonk, Brandon; Singh, Arjun; Sioson, Loretta; Clarkson, Adele; Watson, Nicole; Sheen, Amy; Farzin, Mahtab; Toon, Christopher W; Gill, Anthony J

    2016-06-01

    Germline mutations of the BAP1 gene have been implicated in a cancer predisposition syndrome which includes mesothelioma, uveal melanoma, cutaneous melanocytic lesions, renal cell carcinoma, and possibly other malignancies. Double hit inactivation of BAP1 with subsequent loss of expression of the BAP1 protein also occurs in approximately 50% of mesotheliomas. The link between BAP1 mutation and lung cancer is yet to be fully explored. We sought to assess BAP1 expression in a large cohort of lung cancers undergoing surgery with curative intent. We searched the Anatomical Pathology database of our institution for lung cancer patients undergoing surgery with curative intent between 2000 and 2010. Immunohistochemistry for BAP1 was then performed in tissue microarray format. Our cohort included 257 lung cancer patients, of which 155 (60%) were adenocarcinomas and 72 (28%) were squamous cell carcinomas, with no other subtype comprising more than 3%. BAP1 loss of expression was found in only one lung cancer. We conclude that BAP1 mutation occurs very infrequently (0.4%) in non-small cell lung cancer. Given that the pathological differential diagnosis between lung carcinoma and mesothelioma may sometimes be difficult, this finding increases the specificity of loss of expression for BAP1 for the diagnosis of mesothelioma. Crown Copyright © 2016. Published by Elsevier B.V. All rights reserved.

  1. Radiofrequency ablation in primary non-small cell lung cancer: What a radiologist needs to know

    International Nuclear Information System (INIS)

    Bhatia, Shivank; Pereira, Keith; Mohan, Prasoon; Narayanan, Govindarajan; Wangpaichitr, Medhi; Savaraj, Niramol

    2016-01-01

    Lung cancer continues to be one of the leading causes of death worldwide. In advanced cases of lung cancer, a multimodality approach is often applied, however with poor local control rates. In early non-small cell lung cancer (NSCLC), surgery is the standard of care. Only 15-30% of patients are eligible for surgical resection. Improvements in imaging and treatment delivery systems have provided new tools to better target these tumors. Stereotactic body radiation therapy (SBRT) has evolved as the next best option. The role of radiofrequency ablation (RFA) is also growing. Currently, it is a third-line option in stage 1 NSCLC, when SBRT cannot be performed. More recent studies have demonstrated usefulness in recurrent tumors and some authors have also suggested combination of RFA with other modalities in larger tumors. Following the National Lung Screening Trial (NLST), screening by low-dose computed tomography (CT) has demonstrated high rates of early-stage lung cancer detection in high-risk populations. Hence, even considering the current role of RFA as a third-line option, in view of increasing numbers of occurrences detected, the number of potential RFA candidates may see a steep uptrend. In view of all this, it is imperative that interventional radiologists be familiar with the techniques of lung ablation. The aim of this article is to discuss the procedural technique of RFA in the lung and review the current evidence regarding RFA for NSCLC

  2. Computed tomography-based lung nodule volumetry - do optimized reconstructions of routine protocols achieve similar accuracy, reproducibility and interobserver variability to that of special volumetry protocols?

    International Nuclear Information System (INIS)

    Bolte, H.; Riedel, C.; Knoess, N.; Hoffmann, B.; Heller, M.; Biederer, J.; Freitag, S.

    2007-01-01

    Purpose: The aim of this in vitro and ex vivo CT study was to investigate whether the use of a routine thorax protocol (RTP) with optimized reconstruction parameters can provide comparable accuracy, reproducibility and interobserver variability of volumetric analyses to that of a special volumetry protocol (SVP). Materials and Methods: To assess accuracy, 3 polyurethane (PU) spheres (35 HU; diameters: 4, 6 and 10 mm) were examined with a recommended SVP using a multislice CT (collimation 16 x 0.75 mm, pitch 1.25, 20 mAs, slice thickness 1 mm, increment 0.7 mm, medium kernel) and an optimized RTP (collimation 16 x 1.5 mm, pitch 1.25, 100 mAs, reconstructed slice thickness 2 mm, increment 0.4 mm, sharp kernel). For the assessment of intrascan and interscan reproducibility and interobserver variability, 20 artificial small pulmonary nodules were placed in a dedicated ex vivo chest phantom and examined with identical scan protocols. The artificial lesions consisted of a fat-wax-Lipiodol registered mixture. Phantoms and ex vivo lesions were examined afterwards using commercial volumetry software. To describe accuracy the relative deviations from the true volumes of the PU phantoms were calculated. For intrascan and interscan reproducibility and interobserver variability, the 95 % normal range (95 % NR) of relative deviations between two measurements was calculated. Results: For the SVP the achieved relative deviations for the 4, 6 and 10 mm PU phantoms were - 14.3 %, - 12.7 % and - 6.8 % and were 4.5 %, - 0.6 % and - 2.6 %, respectively, for the optimized RTP. SVP showed a 95 % NR of 0 - 1.5 % for intrascan and a 95 % NR of - 10.8 - 2.9 % for interscan reproducibility. The 95 % NR for interobserver variability was - 4.3 - 3.3 %. The optimized RTP achieved a 95 % NR of - 3.1 - 4.3 % for intrascan reproducibility and a 95 % NR of - 7.0 - 3.5 % for interscan reproducibility. The 95 % NR for interobserver variability was - 0.4 - 6.8 %. (orig.)

  3. Improved radiotherapy for locally advanced Non-Small Cell Lung Carcinoma (NSCLC) patients

    DEFF Research Database (Denmark)

    Ottosson, Wiviann

    to comply with the DIBH technique. For DIBH, the patients are guided to hold their breath almost at their maximum inspiration level during imaging and treatment. This leads to reduction of the breathing motion which decreases the movement of the tumor and OARs. It also expands the lung tissue which...... be reduced by the DIBH method for the lung cancer patients. The overall aim of the clinical part of this thesis was to clarify the potential benefit of offering DIBH gating, compared to free-breathing (FB), for lung cancer patients. Particularly, the benefits for locally advanced non-small cell lung cancer...... (NSCLC) patients were explored. For the dosimetric part of the thesis, the dosimetric aspects of correct dose calculations in heterogeneous patient-like geometries were studied. The clinical aspects of DIBH were evaluated in three different studies, where planning and setup verification images acquired...

  4. Improving chemotherapy for patients with advanced non-small cell lung cancer

    DEFF Research Database (Denmark)

    von Plessen, Christian

    2011-01-01

    INTRODUCTION: Lung cancer is the third most common mortal disease in industrialised countries and the prognosis has been slow to improve. The largest subgroup has locally advanced or metastatic non-small cell lung cancer (NSCLC). Unfortunately, these patients can usually not be cured and the main...... project. The description of the experiences can serve as an example for the improvement of microsystems in settings with similar problems. Finally, in the registry study of Norwegian patients with lung cancer, we found significant geographical and temporal variations of the utilisation of chemotherapy...... that were related to survival. Potential areas of improvement in the system of care for lung cancer are recruitment of patients in clinical studies, standardisation of the processes of care in outpatient clinics, definition of strategic aims of quality, development of balanced quality indicators, as well...

  5. A new design for high stability pressure-controlled ventilation for small animal lung imaging

    International Nuclear Information System (INIS)

    Kitchen, M J; Habib, A; Lewis, R A; Fouras, A; Dubsky, S; Wallace, M J; Hooper, S B

    2010-01-01

    We have developed a custom-designed ventilator to deliver a stable pressure to the lungs of small animals for use in imaging experiments. Our ventilator was designed with independent pressure vessels to separately control the Peak Inspiratory Pressure (PIP) and Positive End Expiratory Pressure (PEEP) to minimise pressure fluctuations during the ventilation process. The ventilator was computer controlled through a LabVIEW interface, enabling experimental manipulations to be performed remotely whilst simultaneously imaging the lungs in situ. Mechanical ventilation was successfully performed on newborn rabbit pups to assess the most effective ventilation strategies for aerating the lungs at birth. Highly stable pressures enabled reliable respiratory gated acquisition of projection radiographs and a stable prolonged (15 minute) breath-hold for high-resolution computed tomography of deceased rabbit pups at different lung volumes.

  6. Ablation of p120-Catenin Altering the Activity of Small GTPase in Human Lung Cancer Cells

    Directory of Open Access Journals (Sweden)

    Nan LIU

    2009-05-01

    Full Text Available Background and objective p120-catenin (p120ctn, a member of the Armadillo gene family, has emerged as an important modulator of small GTPase activities. Therefore, it plays novel roles in tumor malignant phenotype, such as invasion and metastasis, whose mechanism are not well clarified yet. The aim of this study is to explore the roles of p120ctn on the regulation of small GTP family members in lung cancer and the effects to lung cancer invasions andmetastasis. Methods After p120ctn was knocked down by siRNA, in vivo and in vitro analysis was applied to investigate the role and possible mechanism of p120ctn in lung cancer, such as Western Blot, pull-down analysis, and nude mice models. Results p120ctn depletion inactivated RhoA, with the the activity of Cdc42 and Rac1 increased, the invasiveness of lung cancer cells was promoted both in vitro and in vivo . Conclusion p120ctn gene knockdown enhances the metastasis of lung cancer cells, probably by altering expression of small GTPase, such as inactivation of RhoA and activation of Cdc42/Rac1.

  7. Graphite nodule count and size distribution in thin-walled ductile cast iron

    DEFF Research Database (Denmark)

    Pedersen, Karl Martin; Tiedje, Niels Skat

    2008-01-01

    Graphite nodule count and size distribution have been analysed in thin walled ductile cast iron. The 2D nodule counts have been converted into 3D nodule count by using Finite Difference Method (FDM). Particles having a diameter smaller than 5 µm should be neglected in the nodule count as these ar......Graphite nodule count and size distribution have been analysed in thin walled ductile cast iron. The 2D nodule counts have been converted into 3D nodule count by using Finite Difference Method (FDM). Particles having a diameter smaller than 5 µm should be neglected in the nodule count...... as these are inclusions and micro porosities that do not influence the solidification morphology. If there are many small graphite nodules as in thin walled castings only 3D nodule count calculated by FDM will give reliable results. 2D nodule count and 3D nodule count calculated by simple equations will give too low...

  8. Subsolid pulmonary nodules: imaging evaluation and strategic management.

    Science.gov (United States)

    Godoy, Myrna C B; Sabloff, Bradley; Naidich, David P

    2012-07-01

    Given the higher rate of malignancy of subsolid pulmonary nodules and the considerably lower growth rate of ground-glass nodules (GGNs), dedicated standardized guidelines for management of these nodules have been proposed, including long-term low-dose computed tomography (CT) follow-up (≥3 years). Physicians must be familiar with the strategic management of subsolid pulmonary nodules, and should be able to identify imaging features that suggest invasive adenocarcinoma requiring a more aggressive management. Low-dose CT screening studies for early detection of lung cancer have increased our knowledge of pulmonary nodules, and in particular our understanding of the strong although imperfect correlation of the subsolid pulmonary nodules, including pure GGNs and part-solid nodules, with the spectrum of preinvasive to invasive lung adenocarcinoma. Serial CT imaging has shown stepwise progression in a subset of these nodules, characterized by increase in size and density of pure GGNs and development of a solid component, the latter usually indicating invasive adenocarcinoma. There is close correlation between the CT features of subsolid nodules (SSNs) and the spectrum of lung adenocarcinoma. Standardized guidelines are suggested for management of SSNs.

  9. EGFR T790M mutation after chemotherapy for small cell lung cancer transformation of EGFR-positive non-small cell lung cancer

    Directory of Open Access Journals (Sweden)

    Tomoaki Sonoda

    Full Text Available In non-small cell lung cancer (NSCLC with an epidermal growth factor receptor (EGFR mutation, 50%–65% of cases acquire resistance after treatment with EGFR-tyrosine kinase inhibitors (EGFR-TKIs because of an EGFR T790M point mutation and 3%–14% of these cases transformed to small cell lung cancer (SCLC. Generally, the EGFR T790M secondary mutation develops with ongoing ATP competitive inhibition. We present a case of a 76-year-old woman with lung adenocarcinoma harboring an EGFR-L858R mutation who received first-line gefitinib and developed SCLC transformation. She was administered several chemotherapy agents, including a platinum doublet. The primary lesion that showed SCLC transformation had reconverted to adenocarcinoma with EGFR L858R and T790M mutations at the time of a second re-biopsy. Therefore, she was administered osimertinib, which resulted in clinical remission. This case suggested that serial biopsies are necessary even after SCLC transformation. Keywords: NSCLC, EGFR mutation, SCLC transformation, T790M, Osimertinib

  10. Does the IMRT technique allow improvement of treatment plans (e.g. lung sparing) for lung cancer patients with small lung volume: a planning study

    International Nuclear Information System (INIS)

    Komosinska, K.; Kepka, L.; Gizynska, M.; Zawadzka, A.

    2008-01-01

    Aim: We evaluated whether intensity-modulated radiation therapy (IMRT) may offer any advantages in comparison with three-dimensional conformal radiotherapy (3D-CRT) for patients with small lung volume (SLV). Methods: Treatment planning was performed for 10 NSCLC patients with the smallest lung volume (mean: 2241 cc) among 200 patients from our database. For each patient 3D-CRT and IMRT plans were prepared. The goal was to deliver 66 Gy/33 fractions, with dose constraints: mean lung dose (MLD) < 20 Gy, V20 < 35%; spinal cord - Dmax < 45 Gy. When the plan could not meet these criteria, total dose was reduced. The 3D-CRT and IMRT plans were compared. We investigated: prescribed dose, coverage and conformity indices, MLD, V5-V65 in the lung. Results: In 4 out of 10 plans, 3D-CRT did not allow 66 Gy to be delivered, because of predicted pulmonary toxicity. These 4 cases included 3 for which we did not reach 66 Gy with IMRT; still, for these 3 plans the total dose was increased by an average of 9 Gy with IMRT in comparison with 3D-CRT. Coverage indices were similar for both techniques. Conformity indices were better for IMRT plans. MLD was lower in five IMRT and two 3D-CRT plans if equal doses were delivered. The decrease in MLD was seen for cases with large PTV and high PTV/lung volume ratio. Lung V5 was lower for all 3D-CRT plans, 47% vs. 57% for IMRT; V15 and above were larger for 3D-CRT Conclusion: In the planning study, IMRT seems to be a promising technique for cases with SLV, especially when associated with large PT V. (authors)

  11. The incidental pulmonary nodule in a child. Part 1: recommendations from the SPR Thoracic Imaging Committee regarding characterization, significance and follow-up

    Energy Technology Data Exchange (ETDEWEB)

    Westra, Sjirk J. [Massachusetts General Hospital, Division of Pediatric Radiology, Boston, MA (United States); Brody, Alan S. [Cincinnati Children' s Hospital Medical Center, Department of Radiology (CH-1), Cincinnati, OH (United States); Mahani, Maryam Ghadimi [University of Michigan Health System, Section of Pediatric Radiology, C. S. Mott Children' s Hospital Department of Radiology, Ann Arbor, MI (United States); Guillerman, R.P. [Texas Children' s Hospital, Department of Radiology, Houston, TX (United States); Hegde, Shilpa V. [Arkansas Children' s Hospital, Department of Radiology, Little Rock, AR (United States); Iyer, Ramesh S. [Seattle Children' s Hospital, Department of Radiology, Seattle, WA (United States); Lee, Edward Y. [Boston Children' s Hospital, Department of Pediatric Radiology, Boston, MA (United States); Newman, Beverley [Lucile Packard Children' s Hospital at Stanford University, Department of Radiology, Stanford, CA (United States); Podberesky, Daniel J. [Nemours Children' s Hospital, Department of Radiology, Orlando, FL (United States); Thacker, Paul G. [Medical University of South Carolina, Department of Radiology, Charleston, SC (United States)

    2015-05-01

    No guidelines are in place for the follow-up and management of pulmonary nodules that are incidentally detected on CT in the pediatric population. The Fleischner guidelines, which were developed for the older adult population, do not apply to children. This review summarizes the evidence collected by the Society for Pediatric Radiology (SPR) Thoracic Imaging Committee in its attempt to develop pediatric-specific guidelines. Small pulmonary opacities can be characterized as linear or as ground-glass or solid nodules. Linear opacities and ground-glass nodules are extremely unlikely to represent an early primary or metastatic malignancy in a child. In our review, we found a virtual absence of reported cases of a primary pulmonary malignancy presenting as an incidentally detected small lung nodule on CT in a healthy immune-competent child. Because of the lack of definitive information on the clinical significance of small lung nodules that are incidentally detected on CT in children, the management of those that do not have the typical characteristics of an intrapulmonary lymph node should be dictated by the clinical history as to possible exposure to infectious agents, the presence of an occult immunodeficiency, the much higher likelihood that the nodule represents a metastasis than a primary lung tumor, and ultimately the individual preference of the child's caregiver. Nodules appearing in children with a history of immune deficiency, malignancy or congenital pulmonary airway malformation should not be considered incidental, and their workup should be dictated by the natural history of these underlying conditions. (orig.)

  12. Pulmonary nodule: new concepts of an Old Problem

    International Nuclear Information System (INIS)

    Diederich, S.; Wormanns, D.

    2003-01-01

    In the past, a pulmonary nodule was considered malignant until proven otherwise, usually histologically, which frequently required invasive diagnostic procedures. The nodule was mostly detected on conventional chest radiographs and usually larger than 10 mm. Recently, modern (multi-slice) helical CT detects an increasing number of very small (≤ 10 mm) nodules, which are benign in > 95%. Consequently, the exclusion of malignancy demands different diagnostic procedures, which should be predominantly non-invasive. This article presents the current data as well as imaging techniques for the determination of the nature of pulmonary nodules and suggests concepts for the diagnostic approach to small pulmonary nodules. (orig.) [de

  13. Drug development for breast, colorectal, and non-small cell lung cancers from 1979 to 2014.

    Science.gov (United States)

    Nixon, Nancy A; Khan, Omar F; Imam, Hasiba; Tang, Patricia A; Monzon, Jose; Li, Haocheng; Sun, Gavin; Ezeife, Doreen; Parimi, Sunil; Dowden, Scot; Tam, Vincent C

    2017-12-01

    Understanding the drug development pathway is critical for streamlining the development of effective cancer treatments. The objective of the current study was to delineate the drug development timeline and attrition rate of different drug classes for common cancer disease sites. Drugs entering clinical trials for breast, colorectal, and non-small cell lung cancer were identified using a pharmaceutical business intelligence database. Data regarding drug characteristics, clinical trials, and approval dates were obtained from the database, clinical trial registries, PubMed, and regulatory Web sites. A total of 411 drugs met the inclusion criteria for breast cancer, 246 drugs met the inclusion criteria for colorectal cancer, and 315 drugs met the inclusion criteria for non-small cell lung cancer. Attrition rates were 83.9% for breast cancer, 87.0% for colorectal cancer, and 92.0% for non-small cell lung cancer drugs. In the case of non-small cell lung cancer, there was a trend toward higher attrition rates for targeted monoclonal antibodies compared with other agents. No tumor site-specific differences were noted with regard to cytotoxic chemotherapy, immunomodulatory, or small molecule kinase inhibitor drugs. Drugs classified as "others" in breast cancer had lower attrition rates, primarily due to the higher success of hormonal medications. Mean drug development times were 8.9 years for breast cancer, 6.7 years for colorectal cancer, and 6.6 years for non-small cell lung cancer. Overall oncologic drug attrition rates remain high, and drugs are more likely to fail in later-stage clinical trials. The refinement of early-phase trial design may permit the selection of drugs that are more likely to succeed in the phase 3 setting. Cancer 2017;123:4672-4679. © 2017 American Cancer Society. © 2017 American Cancer Society.

  14. Diagnostic work-up of pulmonary nodules. Management of pulmonary nodules detected with low-dose CT screening; Abklaerung von Lungenrundherden. Management durch Frueherkennungsuntersuchungen detektierter pulmonaler Rundherde

    Energy Technology Data Exchange (ETDEWEB)

    Wormanns, D. [Evangelische Lungenklinik Berlin, Berlin (Germany)

    2016-09-15

    Pulmonary nodules are the most frequent pathological finding in low-dose computed tomography (CT) scanning for early detection of lung cancer. Early stages of lung cancer are often manifested as pulmonary nodules; however, the very commonly occurring small nodules are predominantly benign. These benign nodules are responsible for the high percentage of false positive test results in screening studies. Appropriate diagnostic algorithms are necessary to reduce false positive screening results and to improve the specificity of lung cancer screening. Such algorithms are based on some of the basic principles comprehensively described in this article. Firstly, the diameter of nodules allows a differentiation between large (>8 mm) probably malignant and small (<8 mm) probably benign nodules. Secondly, some morphological features of pulmonary nodules in CT can prove their benign nature. Thirdly, growth of small nodules is the best non-invasive predictor of malignancy and is utilized as a trigger for further diagnostic work-up. Non-invasive testing using positron emission tomography (PET) and contrast enhancement as well as invasive diagnostic tests (e.g. various procedures for cytological and histological diagnostics) are briefly described in this article. Different nodule morphology using CT (e.g. solid and semisolid nodules) is associated with different biological behavior and different algorithms for follow-up are required. Currently, no obligatory algorithm is available in German-speaking countries for the management of pulmonary nodules, which reflects the current state of knowledge. The main features of some international and American recommendations are briefly presented in this article from which conclusions for the daily clinical use are derived. (orig.) [German] Lungenrundherde sind die haeufigsten pathologischen Befunde bei Untersuchungen mit der Niedrigdosis-CT zur Lungenkrebsfrueherkennung. Fruehstadien des Lungenkarzinoms manifestieren sich meist als Rundherd

  15. The effect of adenovirus-mediated gene expression of FHIT in small cell lung cancer cells

    DEFF Research Database (Denmark)

    Zandi, Roza; Xu, Kai; Poulsen, Hans S

    2011-01-01

    The candidate tumor suppressor fragile histidine traid (FHIT) is frequently inactivated in small cell lung cancer (SCLC). Mutations in the p53 gene also occur in the majority of SCLC leading to the accumulation of the mutant protein. Here we evaluated the effect of FHIT gene therapy alone...

  16. Decision support systems for incurable non-small cell lung cancer : a systematic review

    NARCIS (Netherlands)

    Révész, D; Engelhardt, E G; Tamminga, J J; Schramel, Franz M N H; Onwuteaka-Philipsen, B.D.; van de Garde, E M W; Steyerberg, E.W.; Jansma, E P; de Vet, Henrica C W; Coupé, V.M.H.

    2017-01-01

    BACKGROUND: Individually tailored cancer treatment is essential to ensure optimal treatment and resource use. Treatments for incurable metastatic non-small cell lung cancer (NSCLC) are evolving rapidly, and decision support systems (DSS) for this patient population have been developed to balance

  17. Outcome of combination chemotherapy in extensive stage small-cell lung cancer

    DEFF Research Database (Denmark)

    Lassen, U N; Hirsch, F R; Osterlind, K

    1998-01-01

    During the past two decades many different treatment regimens of combination chemotherapy have been applied in extensive stage small-cell lung cancer (SCLC). This study was carried out to identify whether these modifications have resulted in an improved overall survival for extensive stage during...

  18. Current concepts of chemotherapy and radiotherapy for small cell lung cancer

    International Nuclear Information System (INIS)

    Braun, T.J.; Bunn, P.A. Jr.

    1986-01-01

    Small cell lung cancer (SCLC) was projected to account for 20%-25% of the greater than 140,000 newly diagnosed lung cancers in 1985. If considered a separate disease entity, it would be the fourth leading cause of death by cancer. Previous studies have demonstrated distinct clinical and biologic features of small cell lung cancer, and early therapeutic trial results have demonstrated a high sensitivity to both chemotherapy and radiotherapy. More recent results demonstrated a marked survival improvement with the use of combination chemotherapy, which potentially cured a small minority of patients. Unfortunately, in most patients, drug resistance usually develops, as do chronic, often debilitating toxicities in the few long-term survivors. Although therapeutic advances have plateaued, new and important insights into the basic biology of the disease made the last several years offer the possibility of exciting new treatment approaches within the next decade. This chapter addresses our current understanding of therapy for small cell lung cancer, the current therapy questions under investigation, and potential future directions in clinical research

  19. Breviscapine suppresses the growth of non-small cell lung cancer

    Indian Academy of Sciences (India)

    Breviscapine (BVP) has previously been shown to inhibit the proliferation of hepatocellular carcinoma cells.However, little is known about the effects of BVP on non-small cell lung cancer (NSCLC) growth. Here, we aimedto study the effects of BVP on human NSCLC growth. We employed A549, NCL-H460 and A549 cells ...

  20. Decision support systems for incurable non-small cell lung cancer: A systematic review

    NARCIS (Netherlands)

    Révész, D. (D.); Engelhardt, E.G. (E. G.); Tamminga, J.J. (J. J.); F.M.N.H. Schramel (Franz); B.D. Onwuteaka-Philipsen (Bregje); E.M.W. van de Garde (Ewoudt); E.W. Steyerberg (Ewout); Jansma, E.P. (E. P.); H.C. de Vet (Henrica C); V.M.H. Coupé (Veerle)

    2017-01-01

    textabstractBackground: Individually tailored cancer treatment is essential to ensure optimal treatment and resource use. Treatments for incurable metastatic non-small cell lung cancer (NSCLC) are evolving rapidly, and decision support systems (DSS) for this patient population have been developed to

  1. Role of free radicals in an adriamycin-resistant human small cell lung cancer cell line

    NARCIS (Netherlands)

    Meijer, C.; Mulder, N H; Timmer-Bosscha, H; Zijlstra, J G; de Vries, E G

    1987-01-01

    In two Adriamycin (Adr) resistant sublines (GLC4-Adr1 and GLC4-Adr2) of a human small cell lung carcinoma cell line, GLC4, cross-resistance for radiation was found. GLC4-Adr1 has an acquired Adr resistance factor of 44 after culturing without Adr for 20 days and GLC4-Adr2, the same subline cultured

  2. Effects of concomitant cisplatin and radiotherapy on inoperable non-small-cell lung cancer

    NARCIS (Netherlands)

    Schaake-Koning, C.; van den Bogaert, W.; Dalesio, O.; Festen, J.; Hoogenhout, J.; van Houtte, P.; Kirkpatrick, A.; Koolen, M.; Maat, B.; Nijs, A.

    1992-01-01

    BACKGROUND AND METHODS: Cisplatin (cis-diamminedichloroplatinum) has been reported to enhance the cell-killing effect of radiation, an effect whose intensity varies with the schedule of administration. We randomly assigned 331 patients with nonmetastatic inoperable non-small-cell lung cancer to one

  3. Bladder Metastasis of non-Small Cell Lung Cancer : an Unusual Cause of Hematuria

    NARCIS (Netherlands)

    Karatas, O. Faruk; Bayrak, Reyhan; Yildirim, M. Erol; Bayrak, Omer; Cimentepe, Ersin; Unal, Dogan

    2009-01-01

    Approximately 2% of bladder malignancies are metastatic. The lung cancer makes metastasis sporadically to the bladder. A-69-year-old female patient presented with a history of pain in kidneys, vomiting and hematuria. Cystoscopic examination of the patient revealed small bladder capacity and solitary

  4. Early death during chemotherapy in patients with small-cell lung cancer

    DEFF Research Database (Denmark)

    Lassen, U N; Osterlind, K; Hirsch, F R

    1999-01-01

    Based on an increased frequency of early death (death within the first treatment cycle) in our two latest randomized trials of combination chemotherapy in small-cell lung cancer (SCLC), we wanted to identify patients at risk of early non-toxic death (ENTD) and early toxic death (ETD). Data were s...

  5. A phase II study of gemcitabine in the treatment of non small cell lung cancer

    NARCIS (Netherlands)

    LeChevalier, T; Gottfried, M; Gatzemeier, U; Shepherd, F; Weynants, P; Cottier, B; Groen, HJM; Rosso, R; Mattson, K; CortesFunes, H; Tonato, M; Burkes, RL; Voi, M; Ponzio, A

    Gemcitabine is a novel pyrimidine nucleoside whose activity has been demonstrated on solid tumors. We report here the results of a multicentre phase II trial of gemcitabine in chemonaive patients with inoperable non small cell lung cancer (NSCLC). Gemcitabine was given weekly at a dose of 1,250

  6. PD-L1 expression in non-small cell lung cancer : Correlations with genetic alterations

    NARCIS (Netherlands)

    Scheel, Andreas H.; Ansen, Sascha; Schultheis, Anne M.; Scheffler, Matthias; Fischer, Rieke N.; Michels, Sebastian; Hellmich, Martin; George, Julie; Zander, Thomas; Brockmann, Michael; Stoelben, Erich; Groen, Harry; Timens, Wim; Perner, Sven; von Bergwelt-Baildon, Michael; Buettner, Reinhard; Wolf, Juergen

    2016-01-01

    Inhibition of the PD-1/PD-L1 pathway may induce anticancer immune responses in non-small cell lung cancer (NSCLC). Two PD-L1 immunohistochemistry (IHC) assays have been approved as companion diagnostic tests for therapeutic anti-PD-1 antibodies. However, many aspects of PD-L1 prevalence and

  7. First-Line Nivolumab in Stage IV or Recurrent Non-Small-Cell Lung Cancer.

    NARCIS (Netherlands)

    Carbone, D.P.; Reck, M.; Paz-Ares, L.; Creelan, B.; Horn, L.; Steins, M.; Felip, E.; Heuvel, M. van den; Ciuleanu, T.E.; Badin, F.; Ready, N.; Hiltermann, T.J.N.; Nair, S.; Juergens, R.; Peters, S.; Minenza, E.; Wrangle, J.M.; Rodriguez-Abreu, D.; Borghaei, H.; umenschein GR, J.r. Bl; Villaruz, L.C.; Havel, L.; Krejci, J.; rral Jaime, J. Co; Chang, H.; Geese, W.J.; Bhagavatheeswaran, P.; Chen, A.C.; Socinski, M.A.

    2017-01-01

    BACKGROUND: Nivolumab has been associated with longer overall survival than docetaxel among patients with previously treated non-small-cell lung cancer (NSCLC). In an open-label phase 3 trial, we compared first-line nivolumab with chemotherapy in patients with programmed death ligand 1

  8. First-Line Nivolumab in Stage IV or Recurrent Non-Small-Cell Lung Cancer

    NARCIS (Netherlands)

    Carbone, D. P.; Reck, M.; Paz-Ares, L.; Creelan, B.; Horn, L.; Steins, M.; Felip, E.; van den Heuvel, M. M.; Ciuleanu, T. -E.; Badin, F.; Ready, N.; Hiltermann, T. J. N.; Nair, S; Juergens, R.; Peters, S.; Minenza, E.; Wrangle, J. M.; Rodriguez-Abreu, D.; Borghaei, H.; Blumenschein, G. R.; Villaruz, L. C.; Havel, L.; Krejci, J.; Corral Jaime, J.; Chang, C. -H.; Geese, W. J.; Bhagavatheeswaran, P.; Chen, Alexander C.; Socinski, M. A.

    2017-01-01

    BACKGROUND Nivolumab has been associated with longer overall survival than docetaxel among patients with previously treated non-small-cell lung cancer (NSCLC). In an open-label phase 3 trial, we compared first-line nivolumab with chemotherapy in patients with programmed death ligand 1

  9. Prognostic classification with laboratory parameters or imaging techniques in small-cell lung cancer

    NARCIS (Netherlands)

    de Jong, Wouter K.; Fidler, Vaclav; Groen, Harry J. M.

    PURPOSE: Our aim in this study was to compare prognostic models based on laboratory tests with a model including imaging information in small-cell lung cancer. PATIENTS AND METHODS: A retrospective analysis was performed on 156 consecutive patients. Three existing models based on laboratory tests

  10. Effect of informing the diagnosis on depressive state in patients with non-small cell lung cancer of stage Ⅲ

    OpenAIRE

    Wei WANG; Ping CHEN; Xianglin PI; Anlan WANG; Xiaoping WEN; Dong HUANG

    2008-01-01

    Background and objective As other tumors, unresectabe lung cancer can cause many psychological problems to the patients, such as depression and anxiety. The present paper aims to evaluate the status of depression before and after knowing the state of illness in patients with non-small cell lung cancer of stage Ⅲ. Methods 43 casesof newly diagnosed non-small cell lung cancer (NSCLC) with stage Ⅲ were enrolled in the study. All the patients were distributed into three groups and given different...

  11. Advanced Research of Fibroblast Growth Factor Receptor 
in Non-small Cell Lung Cancer

    Directory of Open Access Journals (Sweden)

    Dan PU

    2013-11-01

    Full Text Available Lung cancer is severely threatening human health. In recent years, the treatment for lung adenocarcinoma has made a great progress, targeted therapy has been widely applied in clinic, and benefits amount of patients. However, in squamous cell lung cancer, the incidence of epidermal growth factor receptor (EGFR gene mutant and ALK fusion gene are low,and targeted therapy like Tarceva and crizotinib, can hardly work. Since the fibroblast growth factors (fibroblast growth factor, FGF pathway is considered to be related to tumor cell proliferation, metastasis and angiogenesis, more and more researches proved the amplification of fibroblast growth factor receptor (FGFR in squamous cell lung cancer. Experiments in vivo and in vitro found that blocking FGF pathway could reduce the proliferation of tumor cells and inhibit metastasis. The FGF pathway might be a new target for treatment of squamous cell lung cancer. This article reviews the effect of FGFR in tumorigenesis,as well as the prospect as a therapeutic target in non-small cell lung cancer.

  12. Genomic profiling toward precision medicine in non-small cell lung cancer: getting beyond EGFR

    Directory of Open Access Journals (Sweden)

    Richer AL

    2015-02-01

    Full Text Available Amanda L Richer,1 Jacqueline M Friel,1 Vashti M Carson,2 Landon J Inge,1 Timothy G Whitsett2 1Norton Thoracic Institute, St Joseph’s Hospital and Medical Center, 2Cancer and Cell Biology Division, Translational Genomics Research Institute, Phoenix, AZ, USA Abstract: Lung cancer remains the leading cause of cancer-related mortality worldwide. The application of next-generation genomic technologies has offered a more comprehensive look at the mutational landscape across the different subtypes of non-small cell lung cancer (NSCLC. A number of recurrent mutations such as TP53, KRAS, and epidermal growth factor receptor (EGFR have been identified in NSCLC. While targeted therapeutic successes have been demonstrated in the therapeutic targeting of EGFR and ALK, the majority of NSCLC tumors do not harbor these genomic events. This review looks at the current treatment paradigms for lung adenocarcinomas and squamous cell carcinomas, examining genomic aberrations that dictate therapy selection, as well as novel therapeutic strategies for tumors harboring mutations in KRAS, TP53, and LKB1 which, to date, have been considered “undruggable”. A more thorough understanding of the molecular alterations that govern NSCLC tumorigenesis, aided by next-generation sequencing, will lead to targeted therapeutic options expected to dramatically reduce the high mortality rate observed in lung cancer. Keywords: non-small cell lung cancer, precision medicine, epidermal growth factor receptor, Kirsten rat sarcoma viral oncogene homolog, serine/threonine kinase 11, tumor protein p53

  13. Cost and effectiveness studies in non-small cell lung cancer

    Directory of Open Access Journals (Sweden)

    Pinar Yalcin-Balcik

    2015-02-01

    Full Text Available Lung cancer disease diagnosis and treatment is costly. As the numbers of inflicted rise so does the economic burden assumed for this cancer type. When the treatment expenditures are considered for all types of cancer, the lung cancer is thought to occupy a 20% share. The disease examined in two basic groups as small-cell lung cancer and non-small cell lung cancer (NSCLC is the most frequently encountered type of its kind nationally and in the World. This study considers the cost, effectiveness and cost effectiveness of platinum based chemotherapy medications with active ingredients pemetrexed and gemcitabine used for NSCLC. A review of studies relevant to the advanced stage NSCLC where majority of patients are positioned is foreseen to be useful to the decision makers since policy makers, regulating authorities and physicians require more information due to increased overall finance and costs, as well as treatment cost effectiveness. Furthermore, due to the entry attempt of pemetrexed active ingredient to the list of reimbursed medications for the first stage lung cancer treatment, it is assumed that a review of studies containing pemetrexed and gemcitabine will draw the attention of decision makers at the Social Security Instutition. [TAF Prev Med Bull 2015; 14(1.000: 55-64

  14. Functional image-based radiotherapy planning for non-small cell lung cancer: A simulation study

    International Nuclear Information System (INIS)

    Bates, Emma L.; Bragg, Christopher M.; Wild, Jim M.; Hatton, Matthew Q.F.; Ireland, Rob H.

    2009-01-01

    Background and purpose: To investigate the incorporation of data from single-photon emission computed tomography (SPECT) or hyperpolarized helium-3 magnetic resonance imaging ( 3 He-MRI) into intensity-modulated radiotherapy (IMRT) planning for non-small cell lung cancer (NSCLC). Material and methods: Seven scenarios were simulated that represent cases of NSCLC with significant functional lung defects. Two independent IMRT plans were produced for each scenario; one to minimise total lung volume receiving ≥20 Gy (V 20 ), and the other to minimise only the functional lung volume receiving ≥20 Gy (FV 20 ). Dose-volume characteristics and a plan quality index related to planning target volume coverage by the 95% isodose (V PTV95 /FV 20 ) were compared between anatomical and functional plans using the Wilcoxon signed ranks test. Results: Compared to anatomical IMRT plans, functional planning reduced FV 20 (median 2.7%, range 0.6-3.5%, p = 0.02), and total lung V 20 (median 1.5%, 0.5-2.7%, p = 0.02), with a small reduction in mean functional lung dose (median 0.4 Gy, 0-0.7 Gy, p = 0.03). There were no significant differences in target volume coverage or organ-at-risk doses. Plan quality index was improved for functional plans (median increase 1.4, range 0-11.8, p = 0.02). Conclusions: Statistically significant reductions in FV 20 , V 20 and mean functional lung dose are possible when IMRT planning is supplemented by functional information derived from SPECT or 3 He-MRI.

  15. Illness perceptions and quality of life in Japanese and Dutch patients with non-small-cell lung cancer

    NARCIS (Netherlands)

    Kaptein, Ad A.; Yamaoka, Kazue; Snoei, Lucia; Kobayashi, Kunihiko; Uchida, Yuka; van der Kloot, Willem A.; Tabei, Toshio; Kleijn, Wim Chr; Koster, Mariska; Wijnands, Giel; Kaajan, Hans; Tran, Tommy; Inoue, Kenichi; van Klink, Rik; van Dooren-Coppens, Eva; Dik, Hans; Hayashi, Fumi; Willems, Luuk; Annema-Schmidt, Dunja; Annema, Jouke; van der Maat, Bas; van Kralingen, Klaas; Meirink, Corrie; Ogoshi, Kyoji; Aaronson, Neil; Nortier, Hans; Rabe, Klaus

    2011-01-01

    This study examined quality of life (QOL) and illness perceptions in Dutch and Japanese patients with non-small-cell lung cancer, thereby extending the body of knowledge on cultural differences and psychosocial aspects of this illness. 24 Dutch and 22 Japanese patients with non-small-cell lung

  16. The experimental study and clinical application on the detection of pulmonary nodules with low-dose multislice spiral CT

    International Nuclear Information System (INIS)

    Wu Xiaohua; Ma Daqing; Zhang Zhongjia; Ji Jingling; Zhang Yansong

    2004-01-01

    Objective: To investigate the detection rate of pulmonary nodules ,especially nodules ≤5 mm, in variable low-doses, and to evaluate the imaging quality of low-dose MSCT. Methods: Six postmortem specimens of patients with pneumoconiosis after necropsy were fixed at end-inspiratory volume. The fixed specimens were examined by using MSCT with standard dose (130 mA) and low-dose (50, 30, 10 mA, respectively). Low-dose MSCT scans of 40 asymptomatic volunteers and 60 patients with pulmonary metastasis were also examined with 30 mA. The numbers of pulmonary nodules less than 5 mm at standard-dose and different low-dose were recorded. Nodules were assessed by diagnostic confidence ('definite nodule', 'questionable nodule', and 'definite not nodule'). The number of images with artifact in specimens and in 40 volunteers and 60 patients with pulmonary metastasis were recorded. Results: In specimen's study, the Kappa values of groups of low-dose (50, 30, 10 mA) were 0.515, 0.242, and 0.154, respectively. The group of 50 mA had a good coincidence with standard-dose group by U test. The sensitivity of group 50, 30, 10 mA was 88.0%, 78.4%, and 75.0%, respectively. The positive predictive values of which were 98%, 94%, and 93%, respectively. The correction rates of which were 85%, 73%, and 69%, respectively. In specimens' images, subtle linear artifact was showed only in paravertebral lung field in 21 images of 31 at the group of 10 mA. Linear artifacts that affected small nodule detection were showed in lung apexes in 3 of 100 subjects. Conclusion: Low-dose MSCT is expected to improve early detection of lung cancer. Pulmonary nodules less than 5 mm could be reliably detected at 50 mA tube current in specimens. Low-dose CT (30 mA) showed satisfactory imaging quality in our study. Low-dose CT screening for lung cancer may be applied if situation permits. (authors)

  17. Solitary pulmonary nodule

    Science.gov (United States)

    ... Adenocarcinoma - chest x-ray Pulmonary nodule - front view chest x-ray Pulmonary nodule, solitary - CT scan Respiratory system References Gotway MB, Panse PM, Gruden JF, Elicker BM. Thoracic radiology: noninvasive diagnostic imaging. In: Broaddus VC, Mason RJ, ...

  18. The influence of inspiratory effort and emphysema on pulmonary nodule volumetry reproducibility.

    Science.gov (United States)

    Moser, J B; Mak, S M; McNulty, W H; Padley, S; Nair, A; Shah, P L; Devaraj, A

    2017-11-01

    To evaluate the impact of inspiratory effort and emphysema on reproducibility of pulmonary nodule volumetry. Eighty-eight nodules in 24 patients with emphysema were studied retrospectively. All patients had undergone volumetric inspiratory and end-expiratory thoracic computed tomography (CT) for consideration of bronchoscopic lung volume reduction. Inspiratory and expiratory nodule volumes were measured using commercially available software. Local emphysema extent was established by analysing a segmentation area extended circumferentially around each nodule (quantified as percent of lung with density of -950 HU or less). Lung volumes were established using the same software. Differences in inspiratory and expiratory nodule volumes were illustrated using the Bland-Altman test. The influences of percentage reduction in lung volume at expiration, local emphysema extent, and nodule size on nodule volume variability were tested with multiple linear regression. The majority of nodules (59/88 [67%]) showed an increased volume at expiration. Mean difference in nodule volume between expiration and inspiration was +7.5% (95% confidence interval: -24.1, 39.1%). No relationships were demonstrated between nodule volume variability and emphysema extent, degree of expiration, or nodule size. Expiration causes a modest increase in volumetry-derived nodule volumes; however, the effect is unpredictable. Local emphysema extent had no significant effect on volume variability in the present cohort. Copyright © 2017 The Royal College of Radiologists. Published by Elsevier Ltd. All rights reserved.

  19. Optimization of extracranial stereotactic radiation therapy of small lung lesions using accurate dose calculation algorithms

    International Nuclear Information System (INIS)

    Dobler, Barbara; Walter, Cornelia; Knopf, Antje; Fabri, Daniella; Loeschel, Rainer; Polednik, Martin; Schneider, Frank; Wenz, Frederik; Lohr, Frank

    2006-01-01

    The aim of this study was to compare and to validate different dose calculation algorithms for the use in radiation therapy of small lung lesions and to optimize the treatment planning using accurate dose calculation algorithms. A 9-field conformal treatment plan was generated on an inhomogeneous phantom with lung mimics and a soft tissue equivalent insert, mimicking a lung tumor. The dose distribution was calculated with the Pencil Beam and Collapsed Cone algorithms implemented in Masterplan (Nucletron) and the Monte Carlo system XVMC and validated using Gafchromic EBT films. Differences in dose distribution were evaluated. The plans were then optimized by adding segments to the outer shell of the target in order to increase the dose near the interface to the lung. The Pencil Beam algorithm overestimated the dose by up to 15% compared to the measurements. Collapsed Cone and Monte Carlo predicted the dose more accurately with a maximum difference of -8% and -3% respectively compared to the film. Plan optimization by adding small segments to the peripheral parts of the target, creating a 2-step fluence modulation, allowed to increase target coverage and homogeneity as compared to the uncorrected 9 field plan. The use of forward 2-step fluence modulation in radiotherapy of small lung lesions allows the improvement of tumor coverage and dose homogeneity as compared to non-modulated treatment plans and may thus help to increase the local tumor control probability. While the Collapsed Cone algorithm is closer to measurements than the Pencil Beam algorithm, both algorithms are limited at tissue/lung interfaces, leaving Monte-Carlo the most accurate algorithm for dose prediction

  20. Socioeconomic position and surgery for early-stage non-small-cell lung cancer

    DEFF Research Database (Denmark)

    Kærgaard Starr, Laila; Osler, Merete; Steding-Jessen, Marianne

    2013-01-01

    Register 2001-2008 (date of diagnosis, histology, stage, and treatment), the Central Population Register (vital status), the Integrated Database for Labour Market Research (socioeconomic position), and the Danish Hospital Discharge Register (comorbidity). Logistic regression analyses were performed overall......AIM: To examine possible associations between socioeconomic position and surgical treatment of patients with early-stage non-small-cell lung cancer (NSCLC). METHODS: In a register-based clinical cohort study, patients with early-stage (stages I-IIIa) NSCLC were identified in the Danish Lung Cancer...

  1. Facial Nerve Palsy: An Unusual Presenting Feature of Small Cell Lung Cancer

    Directory of Open Access Journals (Sweden)

    Ozcan Yildiz

    2011-01-01

    Full Text Available Lung cancer is the second most common type of cancer in the world and is the most common cause of cancer-related death in men and women; it is responsible for 1.3 million deaths annually worldwide. It can metastasize to any organ. The most common site of metastasis in the head and neck region is the brain; however, it can also metastasize to the oral cavity, gingiva, tongue, parotid gland and lymph nodes. This article reports a case of small cell lung cancer presenting with metastasis to the facial nerve.

  2. Survival outcomes for oligometastasis in resected non-small cell lung cancer.

    Science.gov (United States)

    Shimada, Yoshihisa; Saji, Hisashi; Kakihana, Masatoshi; Kajiwara, Naohiro; Ohira, Tatsuo; Ikeda, Norihiko

    2015-10-01

    We investigated the factors associated with post-recurrence survival and the treatment for non-small-cell lung cancer patients with postoperative distant recurrence, especially oligometastasis. We reviewed the data of 272 patients with distant recurrence who underwent resection of non-small-cell lung cancer from January 2000 through December 2011. The type of distant recurrence was classified as oligometastasis (n = 76, 28%) or polymetastasis (n = 196, 72%). Forty-seven (62%) patients with oligometastasis received local therapy (surgery 5, radiotherapy 9, sequential local and systemic therapy 28, chemoradiotherapy 5). Multivariate analysis revealed older age, non-adenocarcinoma, shorter disease-free interval, no pulmonary metastasis, liver metastases, bone metastases, and polymetastasis had significant associations with unfavorable post-recurrence survival. Subgroup analysis of patients with oligometastasis showed histology and disease-free interval had a great impact on survival. Smoking history and histology were associated with survival in patients with lung oligometastasis, whereas systemic treatment and longer disease-free interval were related to increased post-recurrence survival in those with brain oligometastasis. This study showed that an oligometastatic state per se was a significant favorable factor. Optimization of personalized systemic treatment and adding local treatment are important in the management of patients with non-small-cell lung cancer and oligometastasis. © The Author(s) 2015.

  3. Chemotherapy related toxicity in locally advanced non-small cell lung cancer

    Directory of Open Access Journals (Sweden)

    Bahl Amit

    2006-01-01

    Full Text Available Background: For inoperable non-small cell lung cancer combined chemotherapy and radiotherapy plays an important role as a therapeutic modality. The aim of the present study was to analyze neoadjuvant chemotherapy related acute toxicity in locally advanced lung cancer (stage IIIA and IIIB in Indian patients using Cisplatin and Etoposide combination chemotherapy. Material and methods: Forty patients of locally advanced Non small cell lung cancer received three cycles neoadjuvant chemotherapy using Injection Cisplatin and Etoposide. The patients were taken for Radical radiotherapy to a dose of 60 Gray over 30 fractions in conventional fractionation after completing chemotherapy. Chemotherapy associated toxicity was assessed using common toxicity criteria (CTC v2.0 Results: Forty patients were available for final evaluation. Median age of presentation of patients was fifty-six years. Thirteen patients had Non small cell lung cancer stage IIIA while twenty-seven patients had Stage IIIB disease. Anemia was the most common hematological toxicity observed (seen in 81% of patients. Nausea and vomiting were the most common non -hematological toxicity seen. Sensory neuropathy was seen in 38%of patients. 88% patients developed alopecia. Seven patients developed febrile neutropenias. Conclusion: Neo-adjuvant chemotherapy using Cisplatin and Etoposide continues to be a basic regimen in the Indian set up despite availability of higher molecules, since it is cost effective, well tolerated and therapeutically effective. Blood transfusions, growth factors and supportive care can be used effectively to over come toxicity associated with this regimen.

  4. Immune checkpoint inhibitors: the new frontier in non–small cell lung cancer treatment

    Directory of Open Access Journals (Sweden)

    El-Osta HE

    2016-08-01

    Full Text Available Hazem El-Osta, Kamran Shahid, Glenn M Mills, Prakash Peddi Department of Medicine, Division of Hematology-Oncology, Louisiana State University Health Sciences Center, Shreveport, LA, USA Abstract: Lung cancer is the major cause for cancer-related death in the US. Although advances in chemotherapy and targeted therapy have improved the outcome of metastatic non-small-cell lung cancer, its prognosis remains dismal. A deeper understanding of the complex interaction between the immune system and tumor microenvironment has identified immune checkpoint inhibitors as new avenue of immunotherapy. Rather than acting directly on the tumor, these therapies work by removing the inhibition exerted by tumor cell or other immune cells on the immune system, promoting antitumoral immune response. To date, two programmed death-1 inhibitors, namely nivolumab and pembrolizumab, have received the US Food and Drug Administration approval for the treatment of advanced non-small-cell lung cancer that failed platinum-based chemotherapy. This manuscript provides a brief overview of the pathophysiology of cancer immune evasion, summarizes pertinent data on completed and ongoing clinical trials involving checkpoint inhibitors, discusses the different strategies to optimize their function, and outlines various challenges that are faced in this promising yet evolving field. Keywords: checkpoint inhibitors, immunotherapy, nivolumab, non-small-cell lung cancer, pembrolizumab, programmed death-1, programmed death ligand-1

  5. The significance of PIWI family expression in human lung embryogenesis and non-small cell lung cancer.

    Science.gov (United States)

    Navarro, Alfons; Tejero, Rut; Viñolas, Nuria; Cordeiro, Anna; Marrades, Ramon M; Fuster, Dolors; Caritg, Oriol; Moises, Jorge; Muñoz, Carmen; Molins, Laureano; Ramirez, Josep; Monzo, Mariano

    2015-10-13

    The expression of Piwi-interacting RNAs, small RNAs that bind to PIWI proteins, was until recently believed to be limited to germinal stem cells. We have studied the expression of PIWI genes during human lung embryogenesis and in paired tumor and normal tissue prospectively collected from 71 resected non-small-cell lung cancer patients. The mRNA expression analysis showed that PIWIL1 was highly expressed in 7-week embryos and downregulated during the subsequent weeks of development. PIWIL1 was expressed in 11 of the tumor samples but in none of the normal tissue samples. These results were validated by immunohistochemistry, showing faint cytoplasmic reactivity in the PIWIL1-positive samples. Interestingly, the patients expressing PIWIL1 had a shorter time to relapse (TTR) (p = 0.006) and overall survival (OS) (p = 0.0076) than those without PIWIL1 expression. PIWIL2 and 4 were downregulated in tumor tissue in comparison to the normal tissue (p < 0.001) and the patients with lower levels of PIWIL4 had shorter TTR (p = 0.048) and OS (p = 0.033). In the multivariate analysis, PIWIL1 expression emerged as an independent prognostic marker. Using 5-Aza-dC treatment and bisulfite sequencing, we observed that PIWIL1 expression could be regulated in part by methylation. Finally, an in silico study identified a stem-cell expression signature associated with PIWIL1 expression.

  6. Advances in molecular biology of lung disease: aiming for precision therapy in non-small cell lung cancer.

    Science.gov (United States)

    Rooney, Claire; Sethi, Tariq

    2015-10-01

    Lung cancer is the principal cause of cancer-related mortality in the developed world, accounting for almost one-quarter of all cancer deaths. Traditional treatment algorithms have largely relied on histologic subtype and have comprised pragmatic chemotherapy regimens with limited efficacy. However, because our understanding of the molecular basis of disease in non-small cell lung cancer (NSCLC) has improved exponentially, it has become apparent that NSCLC can be radically subdivided, or molecularly characterized, based on recurrent driver mutations occurring in specific oncogenes. We know that the presence of such mutations leads to constitutive activation of aberrant signaling proteins that initiate, progress, and sustain tumorigenesis. This persistence of the malignant phenotype is referred to as "oncogene addiction." On this basis, a paradigm shift in treatment approach has occurred. Rational, targeted therapies have been developed, the first being tyrosine kinase inhibitors (TKIs), which entered the clinical arena > 10 years ago. These were tremendously successful, significantly affecting the natural history of NSCLC and improving patient outcomes. However, the benefits of these drugs are somewhat limited by the emergence of adaptive resistance mechanisms, and efforts to tackle this phenomenon are ongoing. A better understanding of all types of oncogene-driven NSCLC and the occurrence of TKI resistance will help us to further develop second- and third-generation small molecule inhibitors and will expand our range of precision therapies for this disease.

  7. Percutaneous radiofrequency ablation of lung tumors in a large animal model.

    Science.gov (United States)

    Ahrar, Kamran; Price, Roger E; Wallace, Michael J; Madoff, David C; Gupta, Sanjay; Morello, Frank A; Wright, Kenneth C

    2003-08-01

    Percutaneous radiofrequency ablation (RFA) is accepted therapy for liver tumors in the appropriate clinical setting, but its use in lung neoplasms remains investigational. We undertook this study to evaluate the feasibility and immediate effectiveness of RFA for treatment of both solitary pulmonary nodules and clusters of lung tumors in a large animal model. Percutaneous RFA of 14 lung tumors in five dogs was performed under CT guidance. Animals were euthanatized 8-48 hours after the procedure. The lungs and adjacent structures were harvested for gross and histopathologic evaluation. Five solitary pulmonary nodules (range, 17-26 mm) and three clusters of three nodules each (range, 7-17 mm per nodule) were treated with RFA. All ablations were technically successful. Perilesional ground-glass opacity and small asymptomatic pneumothoraces (n = 4) were visualized during the RFA sessions. One dog developed a large pneumothorax treated with tube thoracostomy but was euthanatized 8 hours post-RFA for persistent pneumothorax and continued breathing difficulty. Follow-up CT 48 hours post-RFA revealed opacification of the whole lung segment. Gross and histopathologic evaluation showed complete thermal coagulation necrosis of all treated lesions without evidence of any viable tumor. The region of thermal coagulation necrosis typically extended to the lung surface. Small regions of pulmonary hemorrhage and congestion often surrounded the areas of coagulation necrosis. RFA can be used to treat both solitary pulmonary nodules and clusters of tumor nodules in the canine lung tumor model. This model may be useful for development of specific RFA protocols for human lung tumors.

  8. Non-small cell lung cancer in never smokers: a clinical entity to be identified.

    Science.gov (United States)

    Santoro, Ilka Lopes; Ramos, Roberta Pulcheri; Franceschini, Juliana; Jamnik, Sergio; Fernandes, Ana Luisa Godoy

    2011-01-01

    It has been recognized that patients with non-small cell lung cancer who are lifelong never-smokers constitute a distinct clinical entity. The aim of this study was to assess clinical risk factors for survival among never-smokers with non-small cell lung cancer. All consecutive non-small cell lung cancer patients diagnosed (n = 285) between May 2005 and May 2009 were included. The clinical characteristics of never-smokers and ever-smokers (former and current) were compared using chi-squared or Student's t tests. Survival curves were calculated using the Kaplan-Meier method, and log-rank tests were used for survival comparisons. A Cox proportional hazards regression analysis was evaluated by adjusting for age (continuous variable), gender (female vs. male), smoking status (never- vs. ever-smoker), the Karnofsky Performance Status Scale (continuous variable), histological type (adenocarcinoma vs. non-adenocarcinoma), AJCC staging (early vs. advanced staging), and treatment (chemotherapy and/or radiotherapy vs. the best treatment support). Of the 285 non-small cell lung cancer patients, 56 patients were never-smokers. Univariate analyses indicated that the never-smoker patients were more likely to be female (68% vs. 32%) and have adenocarcinoma (70% vs. 51%). Overall median survival was 15.7 months (95% CI: 13.2 to 18.2). The never-smoker patients had a better survival rate than their counterpart, the ever-smokers. Never-smoker status, higher Karnofsky Performance Status, early staging, and treatment were independent and favorable prognostic factors for survival after adjusting for age, gender, and adenocarcinoma in multivariate analysis. Epidemiological differences exist between never- and ever-smokers with lung cancer. Overall survival among never-smokers was found to be higher and independent of gender and histological type.

  9. Non-small cell lung cancer in never smokers: a clinical entity to be identified

    Directory of Open Access Journals (Sweden)

    Ilka Lopes Santoro

    2011-01-01

    Full Text Available OBJECTIVES: It has been recognized that patients with non-small cell lung cancer who are lifelong never-smokers constitute a distinct clinical entity. The aim of this study was to assess clinical risk factors for survival among neversmokers with non-small cell lung cancer. METHODS: All consecutive non-small cell lung cancer patients diagnosed (n = 285 between May 2005 and May 2009 were included. The clinical characteristics of never-smokers and ever-smokers (former and current were compared using chi-squared or Student's t tests. Survival curves were calculated using the Kaplan-Meier method, and log-rank tests were used for survival comparisons. A Cox proportional hazards regression analysis was evaluated by adjusting for age (continuous variable, gender (female vs. male, smoking status (never- vs. ever-smoker, the Karnofsky Performance Status Scale (continuous variable, histological type (adenocarcinoma vs. non-adenocarcinoma, AJCC staging (early vs. advanced staging, and treatment (chemotherapy and/or radiotherapy vs. the best treatment support. RESULTS: Of the 285 non-small cell lung cancer patients, 56 patients were never-smokers. Univariate analyses indicated that the never-smoker patients were more likely to be female (68% vs. 32% and have adenocarcinoma (70% vs. 51%. Overall median survival was 15.7 months (95% CI: 13.2 to 18.2. The never-smoker patients had a better survival rate than their counterpart, the ever-smokers. Never-smoker status, higher Karnofsky Performance Status, early staging, and treatment were independent and favorable prognostic factors for survival after adjusting for age, gender, and adenocarcinoma in multivariate analysis. CONCLUSIONS: Epidemiological differences exist between never- and ever-smokers with lung cancer. Overall survival among never-smokers was found to be higher and independent of gender and histological type.

  10. Differences in practice patterns and costs between small cell and non-small cell lung cancer patients in Japan

    International Nuclear Information System (INIS)

    Kuwabara, Kazuaki; Matsuda, Shinya; Fushimi, Kiyohide; Anan, Makoto; Ishikawa, Koichi B.; Horiguchi, Hiromasa; Hayashida, Kenshi; Fujimori, Kenji

    2009-01-01

    Many reports exist regarding the economic evaluation of evolving chemotherapeutic regimens or diagnostic images for lung cancer (LC) patients. However, it is not clear whether clinical information, such as pathological diagnosis or cancer stage, should be considered as a risk adjustment in lung cancer. This study compared the cost and practice patterns between small cell lung carcinoma (SCLC) and non-small cell lung carcinoma (NSCLC) patients. 6,060 LC patients treated at 58 academic hospitals and 14,507 at 257 community hospitals were analyzed. Study variables included demographic variables, comorbid status, cancer stage, use of imaging and surgical procedures, type of adjuvant therapy (chemotherapy, radiation or chemoradiation), use of ten chemotherapeutic agents, length of stay (LOS), and total charges (TC; US$1=100 yen) in SCLC and NSCLC patients. The impact of pathological diagnosis on LOS and TC was investigated using multivariate analysis. We identified 3,571 SCLC and 16,996 NSCLC patients. The proportion of demographic and practice-process variables differed significantly between SCLC and NSCLC patients, including diagnostic imaging, adjuvant therapy and surgical procedures. Median LOS and TC were 20 days and US$6,015 for SCLC and 18 days and US$6,993 for NSCLC patients, respectively (p<0.001 for each variable). Regression analysis revealed that pathological diagnosis was not correlated with TC. Physicians should acknowledge that pathological diagnosis dose not accounts for any variation in cost of LC patients but that should remain as an indicator of appropriate care like selection of chemotherapeutic agents. (author)

  11. Advances in intelligent diagnosis methods for pulmonary ground-glass opacity nodules.

    Science.gov (United States)

    Yang, Jing; Wang, Hailin; Geng, Chen; Dai, Yakang; Ji, Jiansong

    2018-02-07

    Pulmonary nodule is one of the important lesions of lung cancer, mainly divided into two categories of solid nodules and ground glass nodules. The improvement of diagnosis of lung cancer has significant clinical significance, which could be realized by machine learning techniques. At present, there have been a lot of researches focusing on solid nodules. But the research on ground glass nodules started late, and lacked research results. This paper summarizes the research progress of the method of intelligent diagnosis for pulmonary nodules since 2014. It is described in details from four aspects: nodular signs, data analysis methods, prediction models and system evaluation. This paper aims to provide the research material for researchers of the clinical diagnosis and intelligent analysis of lung cancer, and further improve the precision of pulmonary ground glass nodule diagnosis.

  12. Small RNA sequencing reveals metastasis-related microRNAs in lung adenocarcinoma

    DEFF Research Database (Denmark)

    Daugaard, Iben; Venø, Morten T.; Yan, Yan

    2017-01-01

    The majority of lung cancer deaths are caused by metastatic disease. MicroRNAs (miRNAs) are posttranscriptional regulators of gene expression and miRNA dysregulation can contribute to metastatic progression. Here, small RNA sequencing was used to profile the miRNA and piwi-interacting RNA (piRNA......) transcriptomes in relation to lung cancer metastasis. RNA-seq was performed using RNA extracted from formalin-fixed paraffin embedded (FFPE) lung adenocarcinomas (LAC) and brain metastases from 8 patients, and LACs from 8 patients without detectable metastatic disease. Impact on miRNA and piRNA transcriptomes...... was subtle with 9 miRNAs and 8 piRNAs demonstrating differential expression between metastasizing and non-metastasizing LACs. For piRNAs, decreased expression of piR-57125 was the most significantly associated with distant metastasis. Validation by RT-qPCR in a LAC cohort comprising 52 patients confirmed...

  13. COMPARISON OF CONVENTIONAL RADIATIOTHERAPY AND ACCELERATED HYPERFRACTIONATED RADIATIOTHERAPY IN CHEMORADIATION TREATMENT FOR SMALL CELL LUNG CANCER

    Directory of Open Access Journals (Sweden)

    I. A. Gulidov

    2013-01-01

    Full Text Available The 5-year treatment outcomes of 69 patients with stage IIA–IIIA locally advanced small cell lung cancer have been presented. Accelerated hyperfractionated radiotherapy was administered in the uneven daily dose fractionation (single dose of 1 + 1,5 Gy with a 5–6hour interval to a total dose of 60–70 Gy depending on the health status and lung function. The complete response was achieved in 13 (42 % patients, the median survival was 28 months and the 5-year survival rate was 26,2 %. Grade III lung and pericardium toxicities (according to RTOG toxicity scale were observed in 3,2 % and 6,5 % of patients, respectively. No grade III–IV radiation-induced blood and esophageal damages were found.

  14. Advances in surgical techniques in non-small cell lung cancer.

    Science.gov (United States)

    Kim, Anthony W; Detterbeck, Frank C

    2013-12-01

    Thoracic surgery is a dynamic field, and many scientific, technological, technical, and organizational changes are occurring. A prominent example is the use of less invasive approaches to major resection of non-small cell lung cancer (NSCLC), both thoracoscopic and robotic. Sophisticated technology corroborated by clinical data has led to these approaches becoming accepted additions to the armamentarium. Additionally, improvements in perioperative pain management have also contributed to dramatically changing the experience of patients who undergo modern thoracic surgery. Lung cancer is being detected more often at an early stage. At the same time, advances in techniques, patient care, clinical science, and multidisciplinary treatment support an increased role for aggressive resection in the face of larger locally advanced tumors or for those with limited metastatic disease. These advances, conducted in the setting of multidisciplinary decision making, have resulted in real and palpable advancements for patients with lung cancer. Thieme Medical Publishers 333 Seventh Avenue, New York, NY 10001, USA.

  15. Present trends in the treatment of advanced non-small-cell lung cancer

    International Nuclear Information System (INIS)

    Parvez, T.; Iskandrani, A.

    2003-01-01

    Lung cancer is the leading cause of cancer deaths all over the world. As most patients present with advanced disease, major efforts have been made in the treatment of such disease with systemic chemotherapy. Several new agents and new combinations of chemotherapy have been developed recently. This article reviews the randomized clinical trials investigating chemotherapy for advanced non-small cell lung cancer (NSCLC) in relapse or progressive disease while being treated and in elderly patients. Therapies that incorporate new biological agents to target specific defects in lung cancer are also discussed. Several clinical trials have demonstrated improvement in overall survival as well as quality of life with presently available chemotherapy treatment of advanced NSCLC. Better options are available for the elderly as well as those having relapse after first line chemotherapy. Despite all this progress the 5-year survival rate still remains at a dismal 14%. New therapies with good results are still desired. (author)

  16. Artificial life models in lung CTS

    International Nuclear Information System (INIS)

    Sorin, Cheran

    2006-01-01

    A new method for the analysis of 3D medical images is introduced. The algorithm is based on Biological Models of ants known as Artificial Life models. Test images (lung Computed Tomographies) undergo a 3D region growing procedure for the identification of the ribs cage. Active Contour Models (snakes) are used in order to build a confined area where ants are deployed. The ant-based approach, in which steps are allowed in any direction with different probabilities, allows a kind of tunneling effect for the successful identification of small 3D structures that are not clearly connected to the rest of the tree. The best approach is based on a gradient rule for the release of pheromone. A possible application, as part of a Computer Assisted Detection system for the identification of lung nodules, is the removal of the bronchial and vascular tree from lung CTs thus reducing the number of false positives a Nodule Hunter might report. (Full Text)

  17. Effectiveness of palliative radiotherapy in patients with non-small cell lung cancer

    International Nuclear Information System (INIS)

    Chmielewska, E.; Jaskiewicz, P.

    2001-01-01

    Lung cancer is the most frequent malignant neoplasm in Poland. During the last 25 years it has become the first reason of death of men and the second of women in Poland. Patients with non-small cell lung cancer constitute 75% of all lung cancer patients. The therapy of choice for the advanced, non-small cell lung cancer is radiotherapy with palliative assumption. Many papers indicate that this therapy has no influence on long-term survival, hence it is aimed at reducing the symptoms. The therapy brings relief to 70-80% of patients. At present no other method with similar effectiveness is known. The aim of the is study was to assess the effectiveness of palliative radiotherapy as a treatment of the advanced, non-small cell lung cancel, applied as a remedy for the symptoms resulting from the growth of a lung tumour: Improvement of the quality of life and long-term survivals were assessed and prognostic factors were analysed. Between 1990 and 1995, 2330 patients with lung cancer attended the Outpatient Clinic of the Maria Sklodowska-Curie Memorial Cancer Center in Warsaw. There were 1948 patients with the non-small cell lung cancer. From this group 832 patients were qualified to palliative radiotherapy that included the primary tumour. The documentation was found for 803 patients and this group was analysed. The group constituted of 115 women (14.3%) and 688 men (85.7%), aged 28 to 91 (mean 61). In the majority of cases a significant advancement of the disease was found: stage III A in 388 patients (48.3%) and stage III B in 358 patients (44.6%). Retrospective analysis of the results of the treatment was carried out. The material contained information on 803 patients. The basis for the analysis was the survival time. It was measured from the starting date of the irradiation to the date of death or the date of the last available information that the patient lives. The survival probability was calculated with the Kaplan-Meier method. Multidimensional analysis of the

  18. Acute lung injury and persistent small airway disease in a rabbit model of chlorine inhalation

    Energy Technology Data Exchange (ETDEWEB)

    Musah, Sadiatu; Schlueter, Connie F.; Humphrey, David M. [Department of Environmental and Occupational Health Sciences, School of Public Health and Information Sciences, University of Louisville, Louisville, KY (United States); Powell, Karen S. [Research Resource Facilities, University of Louisville, Louisville, KY (United States); Roberts, Andrew M. [Department of Physiology, University of Louisville, Louisville, KY (United States); Hoyle, Gary W., E-mail: Gary.Hoyle@louisville.edu [Department of Environmental and Occupational Health Sciences, School of Public Health and Information Sciences, University of Louisville, Louisville, KY (United States)

    2017-01-15

    Chlorine is a pulmonary toxicant to which humans can be exposed through accidents or intentional releases. Acute effects of chlorine inhalation in humans and animal models have been well characterized, but less is known about persistent effects of acute, high-level chlorine exposures. In particular, animal models that reproduce the long-term effects suggested to occur in humans are lacking. Here, we report the development of a rabbit model in which both acute and persistent effects of chlorine inhalation can be assessed. Male New Zealand White rabbits were exposed to chlorine while the lungs were mechanically ventilated. After chlorine exposure, the rabbits were extubated and were allowed to survive for up to 24 h after exposure to 800 ppm chlorine for 4 min to study acute effects or up to 7 days after exposure to 400 ppm for 8 min to study longer term effects. Acute effects observed 6 or 24 h after inhalation of 800 ppm chlorine for 4 min included hypoxemia, pulmonary edema, airway epithelial injury, inflammation, altered baseline lung mechanics, and airway hyperreactivity to inhaled methacholine. Seven days after recovery from inhalation of 400 ppm chlorine for 8 min, rabbits exhibited mild hypoxemia, increased area of pressure–volume loops, and airway hyperreactivity. Lung histology 7 days after chlorine exposure revealed abnormalities in the small airways, including inflammation and sporadic bronchiolitis obliterans lesions. Immunostaining showed a paucity of club and ciliated cells in the epithelium at these sites. These results suggest that small airway disease may be an important component of persistent respiratory abnormalities that occur following acute chlorine exposure. This non-rodent chlorine exposure model should prove useful for studying persistent effects of acute chlorine exposure and for assessing efficacy of countermeasures for chlorine-induced lung injury. - Highlights: • A novel rabbit model of chlorine-induced lung disease was developed.

  19. Anesthesia condition for 18F-FDG imaging of lung metastasis tumors using small animal PET

    International Nuclear Information System (INIS)

    Woo, Sang-Keun; Lee, Tae Sup; Kim, Kyeong Min; Kim, June-Youp; Jung, Jae Ho; Kang, Joo Hyun; Cheon, Gi Jeong; Choi, Chang Woon; Lim, Sang Moo

    2008-01-01

    Small animal positron emission tomography (PET) with 18 F-FDG has been increasingly used for tumor imaging in the murine model. The aim of this study was to establish the anesthesia condition for imaging of lung metastasis tumor using small animal 18 F-FDG PET. Methods: To determine the impact of anesthesia on 18 F-FDG distribution in normal mice, five groups were studied under the following conditions: no anesthesia, ketamine and xylazine (Ke/Xy), 0.5% isoflurane (Iso 0.5), 1% isoflurane (Iso 1) and 2% isoflurane (Iso 2). The ex vivo counting, standard uptake value (SUV) image and glucose SUV of 18 F-FDG in various tissues were evaluated. The 18 F-FDG images in the lung metastasis tumor model were obtained under no anesthesia, Ke/Xy and Iso 0.5, and registered with CT image to clarify the tumor region. Results: Blood glucose concentration and muscle uptake of 18 F-FDG in the Ke/Xy group markedly increased more than in the other groups. The Iso 2 group increased 18 F-FDG uptake in heart compared with the other groups. The Iso 0.5 anesthesized group showed the lowest 18 F-FDG uptake in heart and chest wall. The small size of lung metastasis tumor (2 mm) was clearly visualized by 18 F-FDG image with the Iso 0.5 anesthesia. Conclusion: Small animal 18 F-FDG PET imaging with Iso 0.5 anesthesia was appropriate for the detection of lung metastasis tumor. To acquire 18 F-FDG PET images with small animal PET, the type and level of anesthetic should be carefully considered to be suitable for the visualization of target tissue in the experimental model

  20. Correlative investigation of dynamic contrast CT and positron emission tomography with 18-fluorodeoxy glucose standardized uptake value in non-small cell lung cancer

    International Nuclear Information System (INIS)

    Ding Qiyong; Hua Yanqing; Zhu Feng; Mao Dingbiao; Ge Xiaojun; Zhang Guozhen; Guan Yihui; Zhao Jun

    2005-01-01

    Objective: To explore the correlation of dynamic enhanced CT attenuation and 18-fluorodeoxy glucose ( 18 F-FDG) standardized uptake value (SUV) in non-small cell lung cancer (NSCLC). Methods: Twenty-eight NSCLC patients and 13 patients with benign nodules (28 male, 13 female; age range 15-79 years, median 57 years; the diameter range from 0.8-4.0 cm, mean 2.2 cm) were examined on Siemens biograph sensation 16 PET-CT with 18 F-FDG. Dynamic enhanced CT scan was performed on Siemens sensation 16 PET-CT or 16 slice CT in 23 patients and other 18 patients had the results of dynamic CT from other hospitals. The mean CT attenuation of ROI on precontrast and postcontrast multi-phase images, the maxium and average SUV of 18 F-FDG were respectively measured. The correlation between the peak attenuation (A PA ) and SUV was analyzed with pearson correlation coefficient test. Results: The CT A PA between NSCLC and benign nodules had no significance difference (t=1.374, P=0.189). The difference of maximum and average SUV between NSCLC and benignity were significant (t=-3.972, P PA , maximum SUV (7.23 ± 4.38), and average SUV (4.93±3.53) (r=-0.040, P=0.839 and r=0.056, P=0.778). Conclusion: There is no correlation between A PA and SUV in NSCLC. SUV is probably not suitable for the evaluation of the effects of anti-angiogenesis therapy. (authors)

  1. A small-scale, rolled-membrane microfluidic artificial lung designed towards future large area manufacturing.

    Science.gov (United States)

    Thompson, A J; Marks, L H; Goudie, M J; Rojas-Pena, A; Handa, H; Potkay, J A

    2017-03-01

    Artificial lungs have been used in the clinic for multiple decades to supplement patient pulmonary function. Recently, small-scale microfluidic artificial lungs