Objective To evaluate the clinical radiological features combined with circulating tumor cells (CTCs) in the diagnosis of invasiveness evaluation of subsolid nodules in lung cancers. Methods Clinical data of 296 patients from the First Hospital of Lanzhou University between February 2019 and February 2021 were retrospectively included. There were 130 males and 166 females with a median age of 62.00 years. Patients were randomly divided into a training set and an internal validation set with a ratio of 3 : 1 by random number table method. The patients were divided into two groups: a preinvasive lesion group (atypical adenomatoid hyperplasia and adenocarcinoma in situ) and an invasive lesion group (microinvasive adenocarcinoma and invasive adenocarcinoma). Independent risk factors were selected by regression analysis of training set and a Nomogram prediction model was constructed. The accuracy and consistency of the model were verified by the receiver operating characteristic curve and calibration curve respectively. Subgroup analysis was conducted on nodules with different diameters to further verify the performance of the model. Specific performance metrics, including sensitivity, specificity, positive predictive value, negative predictive value and accuracy at the threshold were calculated. Results Independent risk factors selected by regression analysis for subsolid nodules were age, CTCs level, nodular nature, lobulation and spiculation. The Nomogram prediction mode provided an area under the curve (AUC) of 0.914 (0.872, 0.956), outperforming clinical radiological features model AUC [0.856 (0.794, 0.917), P=0.003] and CTCs AUC [0.750 (0.675, 0.825), P=0.001] in training set. C-index was 0.914, 0.894 and corrected C-index was 0.902, 0.843 in training set and internal validation set, respectively. The AUC of the prediction model in training set was 0.902 (0.848, 0.955), 0.913 (0.860, 0.966) and 0.873 (0.730, 1.000) for nodule diameter of 5-20 mm, 10-20 mm and 21-30 mm, respectively. Conclusion The prediction model in this study has better diagnostic value, and is more effective in clinical diagnosis of diseases.
ObjectiveTo systematically review the differential diagnostic value of contrast-enhanced ultrasound (CEUS) and contrast-enhanced CT (CECT) for renal solid space-occupying lesions. MethodsDatabases including EMbase, PubMed, The Cochrane Library (Issue 11, 2014), CNKI, CBM, VIP and WanFang Data were searched for diagnostic tests about CEUS and CECT for renal solid space-occupying lesions from inception to September, 2014. Two reviewers independently screened literature, extracted data and assessed the methodological quality of included studies. Then meta-analysis was performed using Meta-Disc 1.4 software. ResultsA total of 13 studies involving 754 specimens were included. The results of meta-analysis showed that:the sensitivity, specificity, positive likelihood ratio, negative likelihood ratio, diagnostic odds ratio (combined effect and its 95%CI) in the CEUS group were 0.96 (95%CI 0.94 to 0.97), 0.77 (95%CI 0.70 to 0.83), 3.82 (95%CI 2.93 to 4.97), 0.06 (95%CI 0.04 to 0.10), 64.33 (95%CI 36.79 to 112.51), and in the CECT group were 0.84 (95%CI 0.81 to 0.87), 0.73 (95%CI 0.65 to 0.79), 2.81 (95%CI 2.22 to 3.56), 0.23 (95%CI 0.16 to 0.34), 13.85 (95%CI 6.79 to 28.26). There were significant differences between the CEUS group (0.960 8, 95%CI 0.927 3 to 0.994 3) and the CECT group (0.866 8, 95%CI 0.788 8 to 0.944 8) in the area under the summary receiver operating characteristic (SROC) curve (P<0.05). The similar results were observed in cases with small renal tumors≤4 cm (AUC:0.973 7 vs. 0.861 3, P<0.05). ConclusionCEUS has higher differential diagnostic value than CECT for renal solid space-occupying lesions.
Stage ⅠA lung adenocarcinoma presented as ground glass dominant on thin-section high-resolution CT scan is a special subtype of lung cancer. The characteristics of this subtype are quite different from the other patients, which presented as lower malignancy and better prognosis. Clinical, pathological and imaging studies have revealed that the proportion of the solid component in part-solid ground glass nodule is closely related with the pathological type and the prognosis of lung cancer. The methods for the assessment of the solid components in the ground glass nodule can be classified into three types, including subjective assessment, two dimensional measurement and three dimensional measurement. This review summarized the advantages and the limitations of these three methods. We also reviewed the clinical application of these techniques.
Objective To analyze characteristics of solid pseudopapillary neoplasm (SPN) of pancreas and to discuss it’s diagnosis and treatment. Methods The clinicopathologic data of 39 patients with pathologically diagnosed as SPN from January 2012 to July 2017 in the First Affiliated Hospital to Xinjiang Medical University were collected, the clinical characteristics, imaging features, diagnosis and treatment methods, and prognosis were analyzed. Results Among the 39 patients, there were 27 benign SPNs and 12 malignant SPNs. There were no significant differences in the gender, age, blood type, clinical manifestations, distribution of tumor sites, morphological features, and proportions of combined calcification, intracapsular hemorrhage, and pancreatic ductal dilatation between the benign and malignant SPN patients (P>0.050). The maximum diameter of the tumor, the integrity of the capsule, and the ratio of the tumor cystic solidity had significant differences (P<0.050) between the benign and malignant SPN patients. That was, in patients with benign SPN, the largest tumor diameter was less than or equal to 5 cm, and the capsule was complete, and the tumor was mainly cystic and solid. Of the 27 patients with benign SPN, 6 underwent the tumor enucleation, 7 underwent the standard pancreatoduodenectomy, 2 underwent the middle pancreas resection, 5 underwent the standard caudal pancreatectomy, and 7 underwent the spleen-preserving caudal pancreatectomy. Of the 12 patients with malignant SPN, 8 underwent the standard pancreatoduodenectomy and 4 underwent the standard caudal pancreatectomy. All the patients were discharged after surgery and no intra-abdominal infection occurred. The pancreatic leakage occurred in 4 patients and recoved after the full drainage. The average follow-up was 24.5 months, no patient had the tumor metastasis or recurrence, and no patient died. Conclusions Incomplete capsule and the largest diameter >5 cm may suggest malignancy of SPN, and near-solid tumors may be indicative of benignancy. Surgery is a crucial and most effective treatment for SPN, and it is suggested that routine radical operation is performed for malignant SPN.
Objective To highlight the characteristics of acute fibrinous and organizing pneumonia ( AFOP) . Methods The clinical, radiological and pathological data of two patients with AFOP were analyzed, and relevant literature was reviewed. Results Two male patients with the age of 48 years and 43 years presented with fever, cough, dyspnea and chest pain. The chest CT scan revealed multiple, bilateral, patchy consolidation distributing in peripheral areas in one case and consolidation in the middle lobe of the right lung and a little pleural effusion in another case. Two patients were diagnosed initially as community acquired pneumonia, but antibiotic treatment was ineffective. After the transbronchial lung biopsy and computed tomography guided percutaneous lung biopsy, pathological examination revealed there were numerous fibrin and organizing tissue in the alveoli without pulmonary hyaline membrane, which were consistent with AFOP. The patients showed significant clinical and radiological improvement after corticosteroid therapy. One patient was stable and the other one died of respiratory failure because of relapse during dose reduction of corticosteroids. Conclusions Patients of AFOP were misdiagnosed as pneumonia easily. Treatment with corticosteroids could be effective to some patients. If the antibiotic treatment was ineffective to the patient with fever and consolidation in the lungs, AFOP should be considered in the differential diagnosis.
In this study, the role of newcastle disease virus (NDV) combined thermic solidified tumor vaccine in inhibiting growth of tumor and immune control was investigated, and rate of inhibiting tumor and cellular immunity were measured. The results showed that rate of inhibiting tumor in experimental group Ⅰ and Ⅱ were 24.8% and 41.1% respectively; average weight of tumor was significantly lower in both experimental groups than in control group, and activity of natural killing (NK) cells in experimental groups was higher than that in control group (Ｐ＜0.01). This suggests that NDV combined thermic solidified tumor vaccine can inhibit growth of tumor and improve activity of NK cells, and their effects are better than that of NDV.
ObjectiveTo explore the differential diagnosis value of airspace consolidation in thoracic CT between organizing pneumonia (OP) and acquired community pneumonia (CAP).MethodsA retrospective study was taken by retrieving the patients CT database from October 2010 to August 2016. Fifty-six consecutive patients with OP and 99 consecutive patients with CAP whose CT showed airspace consolidation were enrolled and their clinical characteristics and radiological characteristics were analyzed.ResultsThe percentage of patients whose CT image showed various amount of air bronchogram (ABG) with different shapes is higher in OP group than that in CAP group (87.5% and 72.7% respectively, χ2=4.558, P=0.033). The median and interquartile range amount of ABG in the OP patients were significantly higher than those in CAP group [4 (ranged from 2 to 8) and 2 (ranged from 0 to 4) respectively, z=3.640, P=0.000]. Morphologically, 58.9% of the OP patients showed entire air bronchogram (EABG) on the thoracic CT, significantly higher than that in CAP group (21.2%) (χ2=22.413, P=0.000). Interrupted ABG was found in 26.3% of CAP patients, while 16.1% of OP patients shared same features and the difference was not statistically significant (χ2=2.125, P=0.148). Traction bronchiectasis and ground glass opacity (GGO) were more likely to be found in the OP patients rather than CAP patients with 26.8% and 39.3% respectively, while they were found in 1.0% and 11.1% in the CAP patients (P<0.05). Reversed halo sign was found only 1.0% of the CAP patients, significantly lower than that in OP group, 26.8% (χ2=25.671, P=0.000). Pleural effusion and bronchial wall thickening were more commonly found in the CAP group with 56.6% and 35.4% respectively. By multivariate logistic analysis, EABG (OR=5.526, P=0.000), traction bronchiectasis (OR=21.564, P=0.010), GGO (OR=4.657, P=0.007) and reversed halo sign (OR=13.304, P=0.023) were significantly associated with OP, while pleural effusion (OR=0.380, P=0.049) and bronchial wall thickening (OR=0.073, P=0.008) were significantly associated with CAP. Other features in thoracic CT coexisting with ABG all reach significance statistically between the OP and CAP group (all P<0.05).ConclusionsAirspace consolidation in thoracic CT may be valuable for the differential diagnosis between OP and CAP. EABG is more commonly found in OP patients than in CAP patients. When EABG exists or ABG coexists with traction bronchiectasis, GGO and reversed halo sign, a diagnose of OP should be considered.
The Monte Carlo N-Particle (MCNP) is often used to calculate the radiation dose during computed tomography (CT) scans. However, the physical calculation process of the model is complicated, the input file structure of the program is complex, and the three-dimensional (3D) display of the geometric model is not supported, so that the researchers cannot establish an accurate CT radiation system model, which affects the accuracy of the dose calculation results. Aiming at these two problems, this study designed a software that visualized CT modeling and automatically generated input files. In terms of model calculation, the theoretical basis was based on the integration of CT modeling improvement schemes of major researchers. For 3D model visualization, LabVIEW was used as the new development platform, constructive solid geometry (CSG) was used as the algorithm principle, and the introduction of editing of MCNP input files was used to visualize CT geometry modeling. Compared with a CT model established by a recent study, the root mean square error between the results simulated by this visual CT modeling software and the actual measurement was smaller. In conclusion, the proposed CT visualization modeling software can not only help researchers to obtain an accurate CT radiation system model, but also provide a new research idea for the geometric modeling visualization method of MCNP.
ObjectiveTo evaluate the role of surgical resection on synchronous multiple pulmonary nodules identified difficultly in clinics.MethodsThe clinical data of 97 patients with synchronous multiple pulmonary nodules who received surgical resection between 2012 and 2019 in Hunan Cancer Hospital were retrospectively analyzed. There were 72 males and 25 females, aged 58.1±9.0 years. Among these patients, there were 78 patients with ipsilateral and 19 patients with bilateral pulmonary nodules. Clinicopathological parameters between main nodules and secondary nodules were evaluated. Perioperative morbidity was also assessed.ResultsThe operation was successfully completed on all patients for the ipsilateral and bilateral lesions. Totally, 71.1% of mian lesions was mostly removed by lobectomy, and the completion rate of video-assisted thoracoscopic surgery (VATS) was 69.1% (67/97); 80.4% of secondary lesions were mostly removed by wedge resection, and the completion rate of VATS was 71.1% (69/97). The incidence of grade 3 or higher complications after unilateral or bilateral surgery was 12.8% and 5.3%, respectively. Postoperative pathology confirmed that the main lesions were malignant in 65 patients (67.0%), mainly adenocarcinoma (63.1%), of which 43.1% were in the stage Ⅰ; 32 patients were benign, mainly tuberculoma (56.3%). There were 29 patients of malignant secondary lesions, 67 benign, and 1 both benign and malignant; the pathological agreement rate of primary and secondary lesions was 54.6% (lung cancer metastases in the lung and all the benign). When the primary lesion was malignant with its diameters of <3 cm, 3-<5 cm, 5-7 cm, >7 cm, the metastatic rate of secondary lesions was 42.5%, 15.8%, 20.0%, 0, respectively. When the primary lesion was malignant with lymph node metastasis, the probability of the secondary lesion being a metastatic tumor was higher than that without lymph node metastasis (46.7% vs. 30.0%, P>0.05). When the primary lesion was malignant and the primary and secondary lesions were located in the same lobe, the secondary lesions were more likely to metastasize (54.5%), while when they were located on different lobes on the same side or different sides, the secondary lesions were more likely to be benign (58.1%, 72.7%), and the possibility of metastasis was small ( 32.6%, 9.1%). When the primary lesion was benign and clinical differential diagnosis was difficult, the secondary lesion was benign.ConclusionFor synchronous multiple pulmonary nodules, the diameter of the primary lesion is large, the metastatic rate of secondary lesions tends to decrease. In ipsilateral synchronous multiple pulmonary nodules, especially with node metastasis, the risk of metastatic nodule increases. Bilateral surgical resection does not significantly increase the perioperative morbidity.
Lung adenocarcinoma has become the most common type of lung cancer. According to the 2015 World Health Organization histological classification of lung cancer, invasive lung adenocarcinoma can be divided into 5 subtypes: lepidic, acinar, papillary, solid, and micropapillary. Relevant studies have shown that the local lobectomy or sublobectomy is sufficient for early lepidic predominant adenocarcinoma, while lobectomy should be recommended for tumors containing micropapillary and solid ingredients (≥5%). Currently, the percentage of micropapillary and solid components diagnosed by frozen pathological examination is 65.7%, and the accuracy of diagnosis is limited. Therefore, to improve the accuracy of diagnosis, it is necessary to seek new methods and techniques. This paper summarized the characteristics and rapid diagnosis tools of early lung adenocarcinoma subtypes.