scholarly journals Diagnosis and outcome of resected solitary pulmonary nodules after liver transplantation

2019 ◽  
Author(s):  
Mari Tone ◽  
Nobuyasu Awano ◽  
Takehiro Izumo ◽  
Hanako Yoshimura ◽  
Tatsunori Jo ◽  
...  
Keyword(s):  
Computed Tomography ◽  
Lung Cancer ◽  
Liver Transplantation ◽  
Early Stage ◽  
Lung Resection ◽  
Invasive Pulmonary Aspergillosis ◽  
Primary Lung Cancer ◽  
Pulmonary Nodules ◽  
Solitary Pulmonary Nodules ◽  
Computed Tomography Scans

Abstract Objective Solitary pulmonary nodules after liver transplantation are challenging clinical problems. Herein, we report the causes and clinical courses of resected solitary pulmonary nodules in patients who underwent liver transplantation. Methods We retrospectively obtained medical records of 68 patients who underwent liver transplantation between March 2009 and June 2016. This study mainly focused on patients with solitary pulmonary nodules observed on computed tomography scans during follow-ups that were conducted until their deaths or February 2019. Results Computed tomography scans revealed solitary pulmonary nodules in 7 of the 68 patients. Definitive diagnoses were obtained using video-assisted lung resection in all seven patients. None experienced major postoperative complications. The final pathologic diagnoses were primary lung cancer in three patients, pulmonary metastases from hepatocellular carcinoma in one patient, invasive pulmonary aspergillosis in one patient, post-transplant lymphoproliferative disorder in one patient, and hemorrhagic infarction in one patient. The three patients with lung cancer were subsequently treated with standard curative resection. Conclusions Solitary pulmonary nodules present in several serious but potentially curable diseases, such as early-stage lung cancer. Patients who present with solitary pulmonary nodules after liver transplantation should be evaluated by standard diagnostic procedures, including surgical biopsy if necessary.

Non-surgical management of early-stage lung cancer

2017 ◽  
Author(s):  
Jim Brown ◽  
Neal Navani
Keyword(s):  
Lung Cancer ◽  
Early Stage ◽  
Pulmonary Nodules ◽  
The Elderly ◽  
Multidisciplinary Teams ◽  
Solitary Pulmonary Nodules ◽  
Early Stage Lung Cancer ◽  
Mortality And Morbidity ◽  
Inoperable Patient ◽  
Ablative Techniques

As low-dose computed tomography screening of ‘high-risk’ smokers is occurring with increasing frequency, the incidental discovery of solitary pulmonary nodules is becoming more frequent, and lung cancer multidisciplinary teams are now often faced with balancing risk and benefit when making decisions regarding the radical treatment of patients with a clinical diagnosis of early lung cancer but borderline fitness. Surgery offers the best prospect of cure but is associated with significant mortality and morbidity; the elderly and frail experience more toxicity and a greater impact on the quality of life. This chapter reviews the criteria for assessing surgical fitness and examines the evidence for minimally invasive and ablative techniques for the treatment of early peripheral lung cancer in the medically inoperable patient.

scholarly journals Computed tomography follow-up identifies radically treatable new primaries after resection for lung cancer

2019 ◽  
Author(s):  
Jenny Mitchell ◽  
Rachel Benamore ◽  
Fergus Gleeson ◽  
Elizabeth Belcher
Keyword(s):  
Computed Tomography ◽  
Lung Cancer ◽  
Early Stage ◽  
Primary Lung Cancer ◽  
Negative Likelihood Ratio ◽  
University Hospitals ◽  
Early Stage Lung Cancer ◽  
X Ray ◽  
Chest X Ray

Abstract OBJECTIVES The optimal imaging programme for the follow-up of patients who have undergone resection of primary lung cancer is yet to be determined. We investigated the incidence and patterns of new and recurrent malignancy after resection for early-stage lung cancer in patients enrolled into a computed tomography (CT) follow-up programme. METHODS We reviewed the outcomes of consecutive patients who underwent CT follow-up after resection of early-stage primary lung cancer at the Oxford University Hospitals NHS Foundation Trust, between 2013 and 2017. RESULTS Four hundred and sixty-six consecutive patients underwent resection of primary lung cancer between 1 January 2013 and 31 March 2017. Three hundred and thirty-one patients (71.0%) were enrolled in CT follow-up. The median follow-up was 98 weeks (range 26–262). Sixty patients (18.2%) were diagnosed with programme-detected malignancy. Recurrence was diagnosed in 36 patients (10.9%), new primary lung cancer in 16 patients (4.8%) and non-lung primary tumours in 8 patients (2.4%). A routine CT scan identified the majority of new primary lung cancers (84.2%) and those with disease recurrence (85.7%). The majority of programme-detected malignancies were radically treatable (55%). The median survival of programme-detected cancers was 92.4 versus 23.0 weeks for patients with clinically detected tumours (P < 0.0001). Utilizing the CT scout image as a surrogate for chest X-ray, the sensitivity of this modality was 16.95% (8.44–28.97%) and specificity was 89.83% (79.17–96.18%). Negative likelihood ratio was 0.92 (0.8–1.07). CONCLUSIONS CT follow-up of surgically treated primary lung cancer patients identifies malignancy at a stage where radical treatment is possible in the majority of patients. Chest X-ray follow-up may not be of benefit following lung cancer resection.

scholarly journals Does aggressive management of solitary pulmonary nodules pay off?

Breathe ◽  
2019 ◽  
Vol 15 (1) ◽  
pp. 15-23 ◽  
Author(s):  
Stefano Elia ◽  
Serafina Loprete ◽  
Alessandro De Stefano ◽  
Georgia Hardavella
Keyword(s):  
Lung Cancer ◽  
Minimally Invasive ◽  
Early Stage ◽  
Large Diameter ◽  
False Negative ◽  
Pulmonary Nodules ◽  
Solitary Pulmonary Nodules ◽  
Early Stage Lung Cancer ◽  
Fdg Uptake ◽  
Negative Results

Indeterminate solitary pulmonary nodules (SPNs), measuring up to 3 cm in diameter, are incidental radiological findings. The ever-growing use of modern imaging has increased their detection. The majority of those nodules are benign; however, the possibility of diagnosing early-stage lung cancer still stands. Guidelines for the management of SPNs have never been validated in prospective comparative studies.Positron emission tomography (PET) is a useful tool to provide functional information on SPNs. However, overall sensitivity and specificity of PET in detecting malignant SPNs of at least 10 mm in diameter are about 90% and false-negative results are reported.The development of video-assisted thoracic surgery has provided minimally invasive diagnosis and treatment of SPNs. In our series, 105 patients underwent surgery based on combined increased18F-labelled 2-fluoro-2-deoxy-d-glucose (FDG) uptake on PET computed tomography and radiological features (morphology and density) without prior histological confirmation. We detected 26 false negatives (24.8%) and only nine false positives (8.57%). Therefore, our minimally invasive surgical approach prevented 25% of patients with lung cancer from a delayed treatmentversusonly 9% undergoing “overtreatment”.In our monocentric cohort, patients with SPNs with large diameter, irregular outline, no calcifications, central location, increased FDG uptake and/or subsolid aspect benefited from a primary surgical resection.

Study the value of lung low dose computed tomography in early detection the malignant pulmonary nodule

2020 ◽  
pp. 7-15
Author(s):  
Ha Hoang ◽  
Tien Doan Dung ◽  
Khoan Le Trong
Keyword(s):  
Computed Tomography ◽  
Lung Cancer ◽  
Early Detection ◽  
Pulmonary Nodule ◽  
Pulmonary Nodules ◽  
Diagnostic Value ◽  
Cross Sectional Study ◽  
Solitary Pulmonary Nodules ◽  
Cross Sectional ◽  
The Right

Background: Early diagnosis of the malignant pulmonary nodules plays an important role in decreasing the mortality, increasing the lifetime and considering as early detection of lung cancer. Objectives: To describe the characteristics and diagnostic value of the malignant suspected signs of pulmonary nodule. Materials and methods: A descriptive cross-sectional study on 33 patients with localized pulmonary nodule which has indications of biopsy or surgery at Hospital of Hue University of Medicine and Pharmacy from 05/2017 to 08/2018. Results: A majority of pulmonary nodules were found in the right upper lobe with 42.4%; solitary pulmonary nodules made up the majority of 75.8%. (Nodules > 21.5 mm: 57.6%; nodules ≤ 21.5 mm: 42.4%; solid nodules: 97% and mixed nodules: 3%, round shape: 42.4% and polygons: 57.6%; irregular margin: 78.8%; regular margin: 21.2%; eccentric and stippled calcification: 18.2%; non-calcification: 81.8%; air-bronchogram in nodules: 39.4%; air-bronchogram (-): 60.6%; fat containing pulmonary nodules: 6.1%, malignant and benign confirmed by biopsy: 39.3% and 60.7% respectively. The sensitivity and specificity of features included size > 21.5 mm; air-bronchogram in nodules, polygons for malignant nodules diagnosis are 81.6%; 92.3%; 76.9% and 60%, 65%, 85% respectively. Conclusions: Three features of nodules: Size ≥ 21.5 mm; air-bronchogram and polygons are suggestive malignant characteristics. The combination of two or more characteristics have the sensitive 92.3% and specific 80% Keywords: pulmonary nodule, thoracic computed tomography, lung cancer.

Lung Cancer: Nodules and Masses

Chest Imaging ◽  
2019 ◽  
pp. 263-268
Author(s):  
Ryo E. C. Benson
Keyword(s):  
Lung Cancer ◽  
Lung Nodule ◽  
Primary Lung Cancer ◽  
Pulmonary Nodules ◽  
Lung Mass ◽  
Solitary Pulmonary Nodules ◽  
Solid Part ◽  
Benign Nodules

The chapter titled Nodules and Masses discusses these frequent imaging manifestations of primary lung cancer. A lung nodule is a roughly spherical, circumscribed density that measures < 3 cm. A lung mass is larger than 3 cm. Lung cancer may manifest as a solitary pulmonary nodule or mass. Most solitary pulmonary nodules on radiographs are benign, and the majority represent granulomas and intrapulmonary lymph nodes. Larger lung nodules and lung masses are more likely to be malignant. Nodule assessment includes determination of size, morphology, attenuation, metabolic activity, enhancement characteristics and growth. A solid lung nodule that is stable for 2 years is generally presumed benign. Sub-solid (part-solid and ground-glass nodules) often represent indolent lung cancer, and different follow-up and management guidelines apply. Confident diagnosis of benign nodules such as granulomas is important, as these lesions do not require imaging follow-up.

A Novel Algorithm for Segmentation of Solitary Pulmonary Nodules in Chest Computed Tomography Based on Three-Dimensional Connected Voxels

2019 ◽  
Vol 9 (8) ◽  
pp. 1622-1629
Author(s):  
Chence Zhang ◽  
Yi Shen ◽  
Qian Kong ◽  
Yucheng Wei ◽  
Bingsen Zhang ◽  
...  
Keyword(s):  
Computed Tomography ◽  
Lung Cancer ◽  
Three Dimensional ◽  
Pulmonary Nodules ◽  
Chest Ct ◽  
Ct Scans ◽  
Solitary Pulmonary Nodules ◽  
Normal Tissues ◽  
Early Stages ◽  
Novel Algorithm

Background: With the increasing incidence of lung cancer, it is prudent to do screenings for individuals at high-risk. Solitary pulmonary nodules (SPNs) are an indication of small tumors or early stages of disease. Therefore, accurate detection of SPNs is important to both clinicians and radiologists. Since a large number of computed tomography (CT) scans are being acquired during a lung cancer screening, there is an urgent need for new automated techniques to detect SPNs. Methods: A novel algorithm for segmentation of SPNs in CT scans based on three-dimensional connected voxels (3DCVs) can be used to screen out potential patients with SPNs. 120 cases of CT scans from a public database (100 positive cases with nodules and 20 negative cases without nodules) and 30 negative cases from the routine CT scans completed in a hospital were used to test the algorithm. The algorithm is based on the fact that most pulmonary nodules are solitary at their early stages. First, find suitable CT values thresholds for CT values to convert pulmonary nodules, normal tissues and air spaces in each chest CT slice into black and white images. Then stack the slices in their originally physical order. This will produce a three-dimensional (3D) matrix with pulmonary nodules and normal tissues constructing their own 3DCVs respectively. Results: Of the 100 positive cases, 93 cases showed positive detection of SPNs and 7 cases did not. Of the 50 negative cases, 48 cases returned a negative result and 2 cases showed as positive result. In this study, the sensitivity is 93% and the specificity is 96% with a 4% false positive rate (FPR). Conclusions: This algorithm can be used to screen out positive chest CT scans efficiently, which will increase efficiency by two to three times than when compared with manual inspection and detection.

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